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March 20, 1978

Severe and Prolonged Renal Insufficiency: Reversal in a Patient With Malignant Hypertension

Author Affiliations

From the Department of Medicine (Dr Bacon) and the Hemodialysis Unit (Dr Ricanati), Cleveland Metropolitan General Hospital, and the Case Western Reserve University School of Medicine (Dr Ricanati), Cleveland.

JAMA. 1978;239(12):1159-1160. doi:10.1001/jama.1978.03280390055025

RECOVERY of renal function in patients with malignant hypertension complicated by severe renal insufficiency has been reported previously, but is rare.1 When dialysis is instituted in such patients, it usually has to be maintained for life even though the hypertension may be controlled. Our patient had malignant hypertension and severe renal insufficiency; with control of hypertension and with regular dialysis, he has recovered sufficient renal function so that he no longer requires dialysis.

Report of a Case  A 44-year-old man was admitted to Cleveland Metropolitan General Hospital on Aug 13, 1975, with dizziness, headaches, confusion, blurred vision, shortness of breath, and marked oliguria of recent onset. There was no past history of renal disease. He had been told that he had hypertension in the past, but he was never treated.On admission, blood pressure was 270/170 mm Hg. Examination of the fundi showed bilateral papilledema, arteriolar narrowing, hemorrhages, and