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Malignant hypertension (MHT) is the most severe form of hypertension, and thrombotic microangiopathy (TMA), one of its complications, has been linked to significant renal outcomes. However, the impact of overweight and obesity on renal prognosis in MHT patients with TMA is not well understood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective cohort enrolled 288 MHT patients with renal TMA from 2008 to 2023. The clinical and histopathological characteristics were recorded based on body mass index (BMI, &lt;\u200925 and \u2265\u200925\u2009kg\/m<jats:sup>2<\/jats:sup>). The outcome was the incidence of kidney failure. The associations of BMI with kidney failure were examined in logistic regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 288 patients, 180 (62.5%) progressed to kidney failure, including 113 (68.5%) patients with BMI &lt;\u200925\u2009kg\/m<jats:sup>2<\/jats:sup>. Participants with obesity had higher levels of hemoglobin, estimated glomerular filtration rate and C3, but lower levels of serum creatinine and IgA nephropathy. BMI \u2265\u200925\u2009kg\/m<jats:sup>2<\/jats:sup> was associated with a better outcome of kidney failure in MHT patients with TMA (odd ratios [ORs]: 0.49 [95% confidence interval (CI): 0.27\u20130.91], <jats:italic>p<\/jats:italic>\u2009=\u20090.025). Male, uric acid, onion skin lesions, and global sclerosis ratio were correlated with higher risk of kidney failure; serum albumin and treatment with renin\u2013angiotensin system blockers were related to lower risk of kidney failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In MHT patients with renal TMA, normal\u2010weight rather than overweight was found to associate with a worse renal prognosis. Management efforts for MHT may be directed toward controlling body weight within a reasonable range for patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcla.25118","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T12:59:30Z","timestamp":1730811570000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Overweight on Renal Prognosis in Malignant Hypertension Patients With Thrombotic Microangiopathy"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3207-1295","authenticated-orcid":false,"given":"Feng","family":"He","sequence":"first","affiliation":[{"name":"Department of Nephrology, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine South China University of Technology  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaocai","family":"Zhou","sequence":"additional","affiliation":[{"name":"Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine South China University of Technology  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenchuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine South China University of Technology  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingji","family":"Lian","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Guangzhou First People's Hospital The Second Affiliated Hospital of South China University of Technology  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianwen","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital Sun Yat\u2010sen University, NHC Key Laboratory of Clinical Nephrology (Sun Yat\u2010Sen University) and Guangdong Provincial Key Laboratory of Nephrology  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengmei","family":"Lin","sequence":"additional","affiliation":[{"name":"Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi","family":"Song","sequence":"additional","affiliation":[{"name":"Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital Sun Yat\u2010sen University, NHC Key Laboratory of Clinical Nephrology (Sun Yat\u2010Sen University) and Guangdong Provincial Key Laboratory of Nephrology  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianbo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital Sun Yat\u2010sen University, NHC Key Laboratory of Clinical Nephrology (Sun Yat\u2010Sen University) and Guangdong Provincial Key Laboratory of Nephrology  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-021-00424-4"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.hjh.0000249710.21146.38"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004872-199508000-00013"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2016.02.035"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfs279"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfac248"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00620117"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2013070754"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-019-0145-4"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.117.09790"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/hr.2012.222"},{"key":"e_1_2_10_13_1","first-page":"1","article-title":"Obesity: Preventing and Managing the Global Epidemic. 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