Reversibility of Grade 4 Hypertensive Retinopathy One Month After Living Donor Kidney Transplant in A 26-Year-Old Woman with IGA Nephropathy Induced End Stage Renal Disease: A Rare Case Report
Main Article Content
Abstract
The patient was a 26-year-old woman; she developed end stage renal disease (ESRD) due to IgA nephropathy. She was on maintenance hemodialysis for one year. Her blood pressure was 160/110 mmHg; barely controlled with 4 different anti-hypertensive drugs. It occasionally rose to 220/130 mmHg at the end of hemodialysis. Fundoscopy revealed Grade 4 Hypertensive Retinopathy and carotid intima media thickness was increased (1.0 mm). Her blood pressure decreased to 140/90 mmHg 3 days after living donor kidney transplant, requiring monotherapy. Fundoscopy one month after transplant showed Grade 2 Hypertensive Retinopathy.
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Acelajado, M. C., Hughes, Z. H., Oparil, S., & Calhoun, D. A. (2019). Treatment of Resistant and Refractory Hypertension. Circulation Research, 124(7), 1061–1070.
https://doi.org/10.1161/CIRCRESAHA.118.312156
II. Agarwal, K. A., Agarwal, U. K., & Pavlakis, M. (2023). Impact of Blood Pressure Control on Graft Survival in Kidney Transplant Recipients. Transplantation Proceedings, 55(1), 98–102. https://doi.org/10.1016/j.transproceed.2022.12.010
III. Arabi, Z., Abdulgadir, M., Youssouf, T., Althani, A., Alhamzah, H., Alhejaili, F., & Elhassan, E. (2022). The Impact of Kidney Transplantation on Systolic and Diastolic Blood Pressure and the Number of Blood Pressure Medications in the First Year Post Kidney Transplantation: FR-PO844. Journal of the American Society of Nephrology, 33, 555–556. https://doi.org/10.1681/ASN.20223311S1555c
IV. Arriozola-Rodríguez, K. J., Serna-Ojeda, J. C., Martínez-Hernández, V. A., & Rodríguez-Loaiza, J. L. (2015). Hypertensive Retinopathy as the First Manifestation of Advanced Renal Disease in a Young Patient: Report of a Case. Case Reports in Ophthalmology, 6(3), 415–419.
https://doi.org/10.1159/000442660
V. Balagobi, B., Niroshan, V., Brammah, T., BavanthanV, Gowribahan, T., & Weerasinghe, N. (2022). Bilateral nephrectomy as a rescue therapy for refractory hypertension in an end stage renal disease patient: 11In Hindu mythology, Brahmastra is considered to be the most powerful weapon.Brahmastra in hypertension management–A case report. International Journal of Surgery Case Reports, 98, 107566.
https://doi.org/10.1016/j.ijscr.2022.107566
VI. Balahura, A.-M., Moroi, Ștefan-I., Scafa-Udrişte, A., Weiss, E., Japie, C., Bartoş, D., & Bădilă, E. (2022). The Management of Hypertensive Emergencies—Is There a “Magical” Prescription for All? Journal of Clinical Medicine, 11(11). https://doi.org/10.3390/jcm11113138
VII. Berindán, K., Nemes, B., Szabó, R. P., & Módis, L. (2017). Ophthalmic Findings in Patients After Renal Transplantation. Transplantation Proceedings, 49(7), 1526–1529.
https://doi.org/10.1016/j.transproceed.2017.06.016
VIII. Blumenfeld, J. D., & Laragh, J. H. (2001). Management of hypertensive crises: The scientific basis for treatment decisions. American Journal of Hypertension, 14(11), 1154–1167.
https://doi.org/10.1016/S0895-7061(01)02245-2
IX. Buhnerkempe, M. G., Prakash, V., Botchway, A., Adekola, B., Cohen, J. B., Rahman, M., Weir, M. R., Ricardo, A. C., & Flack, J. M. (2021). Adverse Health Outcomes Associated With Refractory and Treatment-Resistant Hypertension in the Chronic Renal Insufficiency Cohort. Hypertension (Dallas, Tex. : 1979), 77(1), 72–81.
https://doi.org/10.1161/HYPERTENSIONAHA.120.15064
X. Callus, R., Bugeja, M., Delicata, L., & Mizzi, A. (2017a). Resistant hypertension after kidney transplantation. BMJ Case Reports, 2017, bcr-2017-220307. https://doi.org/10.1136/bcr-2017-220307
XI. Dobrowolski, L. C., Bemelman, F. J., ten Berge, I. J. M., van den Born, B.-J. H., Reekers, J. A., & Krediet, C. T. P. (2015). Renal denervation of the native kidneys for drug-resistant hypertension after kidney transplantation. Clinical Kidney Journal, 8(1), 79–81. https://doi.org/10.1093/ckj/sfu134
XII. Doumas, M., Papademetriou, V., Douma, S., Faselis, C., Tsioufis, K., Gkaliagkousi, E., Petidis, K., & Zamboulis, C. (2011). Benefits from Treatment and Control of Patients with Resistant Hypertension. International Journal of Hypertension, 2011(1), 318549. https://doi.org/10.4061/2011/318549
XIII. Fan, H., Zhang, M., Chen, J., Hao, C., Gu, Y., & Lin, S. (2011). Treatment of carvedilol for refractory hypertension in patients with renal diseases: A multicentre, prospective clinical trial. Biomedicine & Aging Pathology, 1(4), 203–209. https://doi.org/10.1016/j.biomag.2011.06.009
XIV. Fay, K. S., & Cohen, D. L. (2021). Resistant Hypertension in People With CKD: A Review. American Journal of Kidney Diseases, 77(1), 110–121. https://doi.org/10.1053/j.ajkd.2020.04.017
XV. Filippone, E. J., Naccarelli, G. V., & Foy, A. J. (2024). Controversies in Hypertension V: Resistant and Refractory Hypertension. The American Journal of Medicine, 137(1), 12–22.
https://doi.org/10.1016/j.amjmed.2023.09.015
XVI. Gago Fraile, M., Fernandez Fresnedo, G., Gómez-Alamillo, C., de Castro, S. S., & Arias, M. (2009). Clinical and Epidemiological Characteristics of Refractory Hypertension in Renal Transplant Patients. Transplantation Proceedings, 41(6), 2132–2133. https://doi.org/10.1016/j.transproceed.2009.06.078
XVII. Georgianos, P. I., & Agarwal, R. (2023). Hypertension in chronic kidney disease—Treatment standard 2023. Nephrology Dialysis Transplantation, 38(12), 2694–2703.
https://doi.org/10.1093/ndt/gfad118
XVIII. Ginu, P., Sati, A., Murari, T., Kaushik, J., Mishra, S. K., & Sharma, V. K. (2021a). Ocular manifestations in renal allograft recipients: An Indian perspective. Indian Journal of Ophthalmology, 69(4). https://journals.lww.com/ijo/fulltext/2021/04000/ocular_manifestations_in_renal_allograft.25.aspx
XIX. Gluskin, E., Tzukert, K., Mor-Yosef Levi, I., Gotsman, O., Sagiv, I., Abel, R., Bloch, A., Rubinger, D., Aharon, M., Dranitzki Elhalel, M., & Ben-Dov, I. Z. (2019a). Ambulatory monitoring unmasks hypertension among kidney transplant patients: Single center experience and review of the literature. BMC Nephrology, 20(1), 284. https://doi.org/10.1186/s12882-019-1442-7
XX. Gu, B., Che, Q., Li, W., Zhou, C., Xu, D., Wang, J., & Guo, Y. (2013). Refractory hypertension with massive proteinuria may be reversed in renal artery stenosis patients with low proteinuria selectivity index after stenting. 2013, 5(4), E158–E161.
XXI. Jain, A., Jain, A., Sen, S., Bhadauria, D., & Imchen, M. T. (2024). The Spectrum of Ocular Manifestations among Renal Transplant Recipients. Indian Journal of Transplantation, 18, 63–67. https://doi.org/10.4103/ijot.ijot_79_23
XXII. Jaques, D. A., Saudan, P., Martinez, C., Andres, A., Martin, P.-Y., Pechere-Bertschi, A., & Ponte, B. (2021). Relationship between renal function and blood pressure dipping status in renal transplant recipients: A longitudinal study. BMC Nephrology, 22(1), 325. https://doi.org/10.1186/s12882-021-02523-7
XXIII. Kim, H. J., Kim, K. W., Joo, Y. S., Ryu, J., Jung, H.-Y., Jeong, K. H., Kim, M.-G., Ju, M. K., Han, S., Lee, J. S., Kang, K. P., Ro, H., Lee, K. W., Huh, K. H., Kim, M. S., Kim, B. S., & Yang, J. (n.d.).
XXIV. Kolonko, A., Musialik, J., Chudek, J., Bartmańska, M., Słabiak-Błaż, N., Kujawa-Szewieczek, A., Kuczera, P., Kwiecień-Furmańczuk, K., & Więcek, A. (2020). Changes in Office Blood Pressure Control, Augmentation Index, and Liver Steatosis in Kidney Transplant Patients after Successful Hepatitis C Infection Treatment with Direct Antiviral Agents. Journal of Clinical Medicine, 9(4). https://doi.org/10.3390/jcm9040948
XXV. Kubo, M. N., Kayima, J. K., Were, A. J., Ezzi, M. S., McLigeyo, S. O., & Ogola, E. N. (2016). Changes in Blood Pressure Levels and Antihypertensive Medication Use before and after Renal Transplantation among Patients in Nairobi, Kenya: A Comparative Cross-Sectional Study. International Journal of Hypertension, 2016(1), 8450596. https://doi.org/10.1155/2016/8450596
XXVI. Kuźmiuk-Glembin, I., Adrych, D., Tylicki, L., Heleniak, Z., Garnier, H., Wiśniewski, J., Rutkowski, P., Rutkowski, B., & Dębska-Ślizień, A. (2018). Treatment of Hypertension in Renal Transplant Recipients in Four Independent Cross-Sectional Analyses. Kidney and Blood Pressure Research, 43(1), 45–54.
https://doi.org/10.1159/000486905
XXVII. Maasila, A. T., Chandrabose, C. S., Balasubramaniyan, T., Gopalakrishnanan, N., Dhanapriya, J., Dineshkumar, T., Sakthirajan, R., & Aravind, S. G. (2018). Prevalence, Clinical Profiles, and Outcome of Hypertension in Renal Transplant Recipients. Indian Journal of Transplantation, 12(3). https://journals.lww.com/ijjt/fulltext/2018/12030/prevalence,_clinical_profiles,_and_outcome_of.10.aspx
XXVIII. Muxfeldt, E. S., Chedier, B., & Rodrigues, C. I. S. (2019). Resistant and refractory hypertension: Two sides of the same disease? Brazilian Journal of Nephrology, 41(2), 266–274.
https://doi.org/10.1590/2175-8239-JBN-2018-0108
XXIX. Nguyen, M. N., Skov, K., Pedersen, B. B., & Buus, N. H. (2021a). Unattended automated office blood pressure in living donor kidney transplant recipients. Blood Pressure, 30(6), 386–394. https://doi.org/10.1080/08037051.2021.1991778
XXX. Omotoso, A. B., Kolo, P. M., Olanrewaju, T. O., Owoeye, J. F., Biliaminu, S. A., & Olatunji, V. A. (2016). Relationship between retinopathy and renal abnormalities in black hypertensive patients. Clinical Hypertension, 22(1), 19.
https://doi.org/10.1186/s40885-016-0053-x
XXXI. Ooi, Q. L., Tow, F. K. N.-F. H., Deva, R., Kawasaki, R., Wong, T. Y., Colville, D., Ierino, F., Hutchinson, A., & Savige, J. (2015). Microvascular Disease After Renal Transplantation. Kidney and Blood Pressure Research, 40(6), 575–583.
https://doi.org/10.1159/000368533
XXXII. Opelz, G., & Döhler, B. (2005). Improved Long‐Term Outcomes After Renal Transplantation Associated with Blood Pressure Control. American Journal of Transplantation, 5(11), 2725–2731. https://doi.org/10.1111/j.1600-6143.2005.01093.x
XXXIII. Pagonas, N., Bauer, F., Seibert, F. S., Seidel, M., Schenker, P., Kykalos, S., Dürr, M., Reinke, P., Babel, N., Viebahn, R., & Westhoff, T. H. (2019). Intensive blood pressure control is associated with improved patient and graft survival after renal transplantation. Scientific Reports, 9(1), 10507. https://doi.org/10.1038/s41598-019-46991-2
XXXIV. Park, S., Shin, J., Ihm, S. H., Kim, K., Kim, H.-L., Kim, H. C., Lee, E. M., Lee, J. H., Ahn, S. Y., Cho, E. J., Kim, J. H., Kang, H.-T., Lee, H.-Y., Lee, S., Kim, W., & Park, J.-M. (2023a). Resistant hypertension: Consensus document from the Korean society of hypertension. Clinical Hypertension, 29(1), 30. https://doi.org/10.1186/s40885-023-00255-4
XXXV. Raczyńska, D., Ślizień, M., Bzoma, B., Dębska-Ślizień, A., Glasner, L., & Raczyńska, K. (2018). A 10-year monitoring of the eyesight in patients after kidney transplantation. Medicine (Baltimore), 97(6), e9822. PubMed.
https://doi.org/10.1097/md.0000000000009822
XXXVI. Sánchez-Vicente, J. L., López-Herrero, F., Martínez-Borrego, A. C., Lechón-Caballero, B., Moruno-Rodríguez, A., & Molina-Socola, F. E. (2019). Hypertensive choroidopathy, retinopathy and optic neuropathy in renal transplantation failure. Archivos de La Sociedad Española de Oftalmología (English Edition), 94(11), 551–555. https://doi.org/10.1016/j.oftale.2019.07.005
XXXVII. Seeman, T. (2009). Hypertension after renal transplantation. Pediatric Nephrology (Berlin, Germany), 24(5), 959–972.
https://doi.org/10.1007/s00467-007-0627-7
XXXVIII. Seeman, T. (2020). Hypertension in End-Stage Kidney Disease: Transplantation. In J. T. Flynn, J. R. Ingelfinger, & T. Brady (Eds.), Pediatric Hypertension (pp. 1–19). Springer International Publishing. https://doi.org/10.1007/978-3-319-31420-4_49-3
XXXIX. Shantha, G. P. S., Kumar, A. A., Bhaskar, E., Sivagnanam, K., Srinivasan, D., Sundaresan, M., Arthur, P., & Abraham, G. (2010). Hypertensive retinal changes, a screening tool to predict microalbuminuria in hypertensive patients: A cross-sectional study. Nephrology Dialysis Transplantation, 25(6), 1839–1845. https://doi.org/10.1093/ndt/gfp726
XL. Ślizień, M., Raczyńska, D., Biedunkiewicz, B., Dębska-Ślizień, A., & Glasner, L. (2019). Changes in the eye organ after kidney transplantation. Renal Disease and Transplantation Forum, 12(2), 91–95.
XLI. Stabouli, S., Printza, N., Dotis, J., Gkogka, C., Kollios, K., Kotsis, V., & Papachristou, F. (2015). Long-Term Changes in Blood Pressure After Pediatric Kidney Transplantation. American Journal of Hypertension, 29, hpv192. https://doi.org/10.1093/ajh/hpv192
XLII. Sugianto, R. I., Ostendorf, K., Bauer, E., von der Born, J., Oh, J., Kemper, M. J., Buescher, R., Schmidt, B. M. W., Memaran, N., & Melk, A. (2023). Arterial stiffness and blood pressure increase in pediatric kidney transplant recipients. Pediatric Nephrology, 38(4), 1319–1327. https://doi.org/10.1007/s00467-022-05611-4
XLIII. Swales, J. D., Heagerty, A., Russell, G. I., Bing, R. F., Pohl, J. E. F., & Thurston, H. (1982). TREATMENT OF REFRACTORY HYPERTENSION. Originally Published as Volume 1, Issue 8277, 319(8277), 894–896. https://doi.org/10.1016/S0140-6736(82)92162-6
XLIV. Tantisattamo, E., Molnar, M. Z., Ho, B. T., Reddy, U. G., Dafoe, D. C., Ichii, H., Ferrey, A. J., Hanna, R. M., Kalantar-Zadeh, K., & Amin, A. (n.d.).
XLV. Trung, N. L., Toan, P. Q., Trung, N. K., Tuan, V. A., & Huyen, N. T. (2023a). Eye Lesions in Patients After One Year of Kidney Transplantation. Clinical Ophthalmology (Auckland, N.Z.), 17, 2861–2869. https://doi.org/10.2147/OPTH.S424883
XLVI. Uncontrolled hypertension is associated with increased risk of graft failure in kidney transplant recipients: A nationwide population-based study. (n.d.).
XLVII. van Dijk, E. H. C., Soonawala, D., Rooth, V., Hoyng, C. B., Meijer, O. C., de Vries, A. P. J., & Boon, C. J. F. (2017). Spectrum of retinal abnormalities in renal transplant patients using chronic low-dose steroids. Graefe’s Archive for Clinical and Experimental Ophthalmology = Albrecht von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie, 255(12), 2443–2449.
https://doi.org/10.1007/s00417-017-3823-6
XLVIII. Verdalles, Ú., Goicoechea, M., Garcia de Vinuesa, S., Quiroga, B., Galan, I., Verde, E., Perez de Jose, A., & Luño, J. (2016). Prevalence and characteristics of patients with resistant hypertension and chronic kidney disease. Nefrología (English Edition), 36(5), 523–529. https://doi.org/10.1016/j.nefroe.2016.04.014
XLIX. Vergoulas, G. (2007). Antihypertensive agents and renal transplantation. Hippokratia, 11(1), 3–12. PubMed.
L. Yahr, J., Thomas, G., Calle, J., & Taliercio, J. J. (2023a). Resistant hypertension: A stepwise approach. Cleveland Clinic Journal of Medicine, 90(2), 115. https://doi.org/10.3949/ccjm.90a.22046
LI. Yilmaz, R., Yildirim, T., Abudalal, A., & Erdem, Y. (2022). Impact of the kidney transplantation on renalase and blood pressure levels in renal transplant donors and recipients. Nefrología, 42(2), 171–176. https://doi.org/10.1016/j.nefro.2021.01.015