Prognostic indicators of recovery in malignant hypertension - abstract

ABSTRACT

Experience with renal failure due to malignant hypertension was reviewed for prognostic factors indicative of recovery of self-sustaining renal function (SSRF) and to define an approach to management in the Eastern Caribbean. All patients admitted to the Queen Elizabeth Hospital between March 1979 and March 1985 with malignant hypertension and significant renal failure (plasma creatinine level greater than 176 micromol/l) were studied. The contributions of age, sex, duration of hypertension and of symptoms prior to admission, urine volume and plasma creatinine levels (on admission and one month later), and of renal size were assessed. Only sex, renal size and mean plasma creatinine level (for the group) at one month were predictive of the likelihood of recovery of SSRF. All four female patients recovered SSRF whereas only 2 0f 9 male patients did so, a difference which was statistically significant (p<0.01). Patients recovering SSRF had combined renal lengths greater than 18.0 cm; patients failing to do so had combined renal lengths less than 16.0 cm or shruken kidneys which could not be accurately measured on infusion pyelography. The admission plasma creatinine levels in the 2 males who recovered were lowest (less than 800 micromol/l) among the male patients. Particularly in male patients, then, there is great urgency in the diagnosis and control of malignant hypertension. Patient with renal impairment warrant early referral to specialist units for the aggresive reduction of blood pressure which may frequently require temporary dialysis support. Thereafter, determination of renal size should be followed by renal biopsy in cases with normal or near normal renal size and by prolonged dialysis in those with preservation of glomerular architecture. With minoxidil therapy, 50 percent of patients may be expected to recover SSRF and larger numbers may do so if referral is sufficiently expeditious (AU)