Although TMA could be complication of MHT,[11] it could also “act” as 1 of the clinical features of TMA, like complement associated atypical hemolytic uremic syndrome.[12] Recently, Sameg et al evaluated the role of complement in 9 consecutive patients with biopsy-proven renal TMA attributed to severe hypertension, and found mutations C3 in 3, CFI in 1, CD46 in 1, and/or CFH in 2.[13] Thus, further explorations on complement, including their genetic mutations and circulation activation status is needed for such cases in the future. The gene discussed is CD46; the disease is malignant hypertension.