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The article is on a clinical case of malignant arterial hypertension in predominant kidney damage in a young man with disease anamnesis lasting 17 years. Recent data on the disorder provided, aspects of its management complexity that do make to regard the problem far from solution.

The literature review provides data from studies on the clinical characteristics and features of the course of arterial hypertension in patients with chronic glomerulonephritis. The information on the clinical, instrumental and morphological variants of the malignant and therapy-resistant course of hypertension, possible mechanisms of the formation of the drug resistance syndrome are presented. The role of 24-hour blood pressure monitoring methods for elimination of resistance and its prevention was evaluated.

The literature review provides scientific data on the main mechanisms of the development and progression of arterial hypertension in patients with glomerulonephritis, including genetically determined ones. The mechanisms of vascular kidney damage during the formation of hypertension with hyperuricemia and obesity have been specified. Morphological data are discussed according to which not only vascular damage to arterial structures, but also hyperplasia of intact glomeruli and changes in tubulointerstitium are involved in the formation of hypertension syndrome.

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