Download Full Text (449 KB)


Internal Medicine

Training Level

Resident PGY 2


Henry Ford Macomb


Introduction: It is established that Focal Segmental Glomerulosclerosis (FSGS) can lead to difficult to control hypertension. It has also been shown that malignant hypertension can cause microangiopathic hemolytic anemia (MAHA). We present an interesting case of a young patient who we believe developed undiagnosed FSGS that led to hypertension. Without diagnosis and appropriate treatment, the patient presented with hypertensive crisis, acute renal failure, and MAHA. Case description: Our patient is a 19 year old male with no past medical history who presented to the emergency department with nausea, vomiting, subjective fever, and fatigue. He was markedly hypertensive on presentation. Initial blood work revealed renal failure, anemia, and thrombocytopenia. Examination of peripheral smear demonstrated marked schistocytosis. The patient was started on nicardipine drip for hypertensive emergency and was empirically treated for Thombotic Thrombocytopenic Purpura, undergoing three sessions of PLEX. The patient’s anemia, thrombocytopenia, and hypertension improved, however, renal function did not. He underwent renal biopsy which revealed Focal Segmental Glomerulosclerosis. ADAMTS13 resulted two weeks after treatment and was within normal limits. Discussion: This patient’s presentation was concerning for thrombotic thrombocytopenic purpura. Given the prolonged turnaround time for the ADAMTS13 assay, he was empirically treated. However, in hindsight we believe this patient developed FSGS with subsequent hypertension that went undiagnosed and untreated for an unknown period of time, leading to his presentation of microangiopathic hemolytic anemia secondary to hypertensive crisis.

Presentation Date


Differentiating TTP from Hypertensive Hemolytic Anemia