Renal hemosiderosis with uncontrolled hypertension

Excerpt

A 41-year-old man presented with blurred vision, accompanying with severe hypertension. Blood pressure was 240/130 mmHg. Laboratory results were BUN 64.3 mg/dL, creatinine 4.02 mg/dL, hemoglobin 8.9 g/dL, and low haptoglobin 24.9 mg/dL. A kidney biopsy showed marked arterial wall thickening and fibrosis, and heavy brown pigments in proximal and distal tubules. Extensive hemosiderin deposits in the tubular cells were highlighted by Prussian blue iron stain (Fig. 1a, b). The patient was diagnosed as renal hemosiderosis with acute tubular injury and hypertensive arteriosclerosis due to malignant hypertension. Interestingly, heme oxygenase 1 (HO-1) is an inducible enzyme which catabolizes heme, and is upregulated rapidly exposed to heme proteins for cellular protection and adapt heme overload [1]. Accordingly, intensity of HO-1 immunostaining increased within tubules (Fig. 1c). After taking anti-hypertensive medication, serum creatinine was decreased to 2.1 mg/dL and hemoglobin was increased to 11.6 g/dL. His blurred vision was also recovered. …