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Eun Y, Kim JH, Lim SH, Ahn YH, Kang HG, Ha IS. Two cases of children presenting with polydipsia, polyuria, and malignant hypertension: Answers. Pediatr Nephrol 2022; 37:559-561. [PMID: 34727244 DOI: 10.1007/s00467-021-05236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Yong Eun
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ji Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seon Hee Lim
- Department of Pediatrics, Uijeongbu Eulji Medical Center, Uijeongbu-si, Republic of Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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2
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Kara MA, Kilic BD, Karakus SC, Sahin N, Buyukcelik M, Balat A. Hyponatremic-hypertensive Syndrome in a 19-month-old Boy with Renovascular Hypertension. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:S87-S90. [PMID: 37102529 DOI: 10.4103/1319-2442.374386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Hyponatremic-hypertensive syndrome (HHS) is an uncommon disorder rarely seen in children. Herein, we report a 19-month-old boy with HHS. He had severe hypertension, polyuria, polydipsia, vomiting, and seizure at presentation. Laboratory findings revealed hyponatremia, hypokalemia, metabolic alkalosis, proteinuria, hypercalciuria, high levels of renin and aldosterone, and renal artery stenosis. All symptoms resolved after nephrectomy. Clinicians should be aware of this syndrome because prompt recognition can be lifesaving.
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Affiliation(s)
- Mehtap Akbalik Kara
- Department of Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | | | | | - Nimet Sahin
- Gaziantep Children's Hospital, Gaziantep, Turkey
| | - Mithat Buyukcelik
- Department of Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ayse Balat
- Department of Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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3
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Hinokuma N, Sakurai S, Shiratori A, Nagahara K, Abe Y, Shimizu T, Fujii T, Mizuno K, Tomita H. A pediatric patient with hyponatremic hypertensive syndrome without persistent hypertension in acute phase: A case report and review of literature. SAGE Open Med Case Rep 2020; 8:2050313X20969559. [PMID: 33294189 PMCID: PMC7705808 DOI: 10.1177/2050313x20969559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 10/07/2020] [Indexed: 11/16/2022] Open
Abstract
Hyponatremic hypertensive syndrome is characterized by hypertension, hyponatremia, and hypokalemia due to unilateral renal artery stenosis. We herein report a 1-year-old hyponatremic hypertensive syndrome infant without persistent hypertension in the acute phase. On the ninth hospital day, his systolic and diastolic blood pressure increased up to 154-160 and 70-84 mmHg, respectively. Acute gastroenteritis and dehydration might transiently mask his hypertension. By percutaneous transluminal balloon angioplasty for right renal artery, his blood pressure finally normalized without antihypertensive drugs. We reviewed 23 previously reported pediatric patients with hyponatremic hypertensive syndrome under the age of 15 years. Including our patient, there are only three reports on hyponatremic hypertensive syndrome without persistent hypertension in the acute phase. Hyponatremic hypertensive syndrome is curable with proper diagnosis and timely intervention. Therefore, pediatricians should pay attention to the signs and symptoms associated with hyponatremic hypertensive syndrome, even if persistent hypertension was absent in the acute phase.
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Affiliation(s)
- Nodoka Hinokuma
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Shunsuke Sakurai
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | | | - Keiko Nagahara
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Yoshifusa Abe
- Children's Medical Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Takeshi Shimizu
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, Tokyo, Japan
| | - Takanari Fujii
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, Tokyo, Japan
| | - Katsumi Mizuno
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Hideshi Tomita
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, Tokyo, Japan
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4
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Ding JJ, Lin SH, Lai JY, Wu TW, Huang JL, Chung HT, Tseng MH. Unilateral renal artery stenosis presented with hyponatremic-hypertensive syndrome - case report and literature review. BMC Nephrol 2019; 20:64. [PMID: 30791890 PMCID: PMC6385391 DOI: 10.1186/s12882-019-1246-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/01/2019] [Indexed: 12/20/2022] Open
Abstract
Background Renal artery stenosis is one of the secondary causes of pediatric hypertension. Cases with critical unilateral renal artery stenosis manifesting with the hyponatremic hypertensive syndrome are rare and a comprehensive description of this disorder in the pediatric population is lacking in the literature. Case presentation We describe a 4-year-old boy who presented with severe hypertension, profound hyponatremia, hypokalemia, nephrotic range proteinuria, and polyuria. Distinctly, the diagnosis of hyponatremic hypertensive syndrome secondary to unilateral renal artery stenosis was confirmed in light of laboratory and radiographic findings of severe natriuresis, elevated renin, and unilateral small kidney. Two weeks following nephrectomy, there was resolution of hyponatremia, hypokalemia, nephrotic range proteinuria and hypertension. Conclusions Findings of hyponatremia, hypokalemia, hypertension, polyuria, and unilateral renal hypoplasia can be attributed to a unifying pathology of unilateral renal artery stenosis. Electronic supplementary material The online version of this article (10.1186/s12882-019-1246-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jhao-Jhuang Ding
- Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, No 5, Fu-Shing ST., Kwei-Shan, 33305, Taoyuan, Taiwan.,Department of Pediatrics, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology, Department of Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Jin-Yao Lai
- Division of Pediatric Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Linkou, Taiwan
| | - Tai-Wei Wu
- Department of Pediatrics, Fetal and Neonatal Institute, Division of Neonatology Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jing-Long Huang
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Tao Chung
- Division of Cardiology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Min-Hua Tseng
- Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, No 5, Fu-Shing ST., Kwei-Shan, 33305, Taoyuan, Taiwan.
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5
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Bursztyn M, Touyz RM, Laffer CL, Carey RM, Dominiczak AF. Case of Severe Hypertension and Nephrotic Range Proteinuria. Hypertension 2018; 71:956-961. [PMID: 29610267 DOI: 10.1161/hypertensionaha.118.11045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Bursztyn
- From the Hypertension Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel (M.B.)
| | - Rhian M Touyz
- From the Hypertension Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel (M.B.)
| | - Cheryl L Laffer
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (C.L.L.)
| | - Robert M Carey
- and Division of Endocrinology and Metabolism, University of Virginia Health Sciences Center, Charlottesville (R.M.C.)
| | - Anna F Dominiczak
- From the Hypertension Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel (M.B.)
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6
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Mukherjee D, Sinha R, Akhtar MS, Saha AS. Hyponatremic hypertensive syndrome - a retrospective cohort study. World J Nephrol 2017; 6:41-44. [PMID: 28101450 PMCID: PMC5215207 DOI: 10.5527/wjn.v6.i1.41] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/02/2016] [Accepted: 10/27/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To ascertain the frequency of hyponatremic hypertensive syndrome (HHS) in a cohort of children with hypertensive emergency in a tertiary pediatric hospital.
METHODS A retrospective review was undertaken among children with hypertensive emergency admitted in our tertiary children hospital between June 2014 and December 2015 with an aim to identify any children with HHS. Three children with HHS were identified during this period.
RESULTS The 3 patients with HHS presented with hypertensive emergency. They were initially managed with Labetalol infusion and thereafter switched to oral anti-hypertensives (combination of Nifedipine sustained release, Hydralazine and Beta Blocker). All 3 were diagnosed to have unilateral renal artery stenosis. One child was lost to follow up, whereas the other 2 underwent renal angioplasty which was followed with normalization of blood pressure.
CONCLUSION Despite activation of renin angiotensin axis secondary to renal artery stenosis, these groups of children have significant hyponatremia. Renal re-vascularisation produces excellent results in most of them.
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Shao L, Gao Y, Xu Y, Lang Y. Percutaneous Transluminal Revascularization following an Angiotensin Receptor Blocker: Successful Treatment for Flash Pulmonary Edema and Hyponatremic Hypertensive Syndrome. Cardiorenal Med 2012; 2:184-189. [PMID: 22969774 DOI: 10.1159/000339297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/03/2012] [Indexed: 11/19/2022] Open
Abstract
Either flash pulmonary edema or hyponatremic hypertensive syndrome has been described in renal artery stenosis. However, coexistence of these two disorders has never been previously reported. We describe a patient who presented with flash pulmonary edema and hyponatremic hypertensive syndrome associated with bilateral renal artery disease (one complete occlusion, one highly critical renal artery stenosis, the equivalent of unilateral stenosis of a solitary functioning kidney). His blood pressure, hyponatremia, and symptoms of acute heart failure were much improved by an angiotensin receptor blocker. After the procedure of percutaneous transluminal revascularization, his stenotic kidney function and serum sodium levels were completely restored.
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Affiliation(s)
- Leping Shao
- Department of Nephrology, Affiliated Hospital of Qingdao University School of Medicine, Qingdao, PR China
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Kovalski Y, Cleper R, Krause I, Dekel B, Belenky A, Davidovits M. Hyponatremic hypertensive syndrome in pediatric patients: is it really so rare? Pediatr Nephrol 2012; 27:1037-40. [PMID: 22366877 DOI: 10.1007/s00467-012-2123-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 12/23/2011] [Accepted: 01/23/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hyponatremic hypertensive syndrome (HHS) is characterized by unilateral renal artery stenosis with secondary hypertension and glomerular and tubular dysfunction due to hyperfiltration and activation of the renin-angiotensin system (RAS). CASE-DIAGNOSIS/TREATMENT We describe four children with HHS. All presented with polyuria and polydipsia, electrolyte disturbances, metabolic alkalosis, variable tubular dysfunction, and nephrotic range proteinuria along with hypertension. Interestingly, in one patient, glomerular and tubular abnormalities preceded the development of hypertension. All symptoms resolved after the underlying renal ischemia was corrected by percutaneous angioplasty. CONCLUSION Hyponatremic hypertensive syndrome may be more common in children than previously thought. Clinicians should be alert of the signs and symptoms because cure is possible with timely diagnosis and treatment.
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Affiliation(s)
- Yael Kovalski
- Institute of Pediatric Nephrology, Schneider Children's Medical Center of Israel, Petach Tikva, 49202, Israel
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Poggi GM, Fognani G, Cuzzubbo D, Liguori A, Resti M, Pela I. Neuroblastoma presenting with acute kidney injury, hyponatremic-hypertensive-like syndrome and nephrotic proteinuria in a 10-month-old child. Case Rep Oncol 2011; 4:400-5. [PMID: 21941489 PMCID: PMC3177796 DOI: 10.1159/000331211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Neuroblastoma is the most common extracranial solid tumor in childhood. Its presenting signs and symptoms may be highly variable, depending on the location of the primary tumor and its local or metastatic diffusion and, rarely, with paraneoplastic syndrome such as opsoclonus-myoclonus-ataxia syndrome and gastrointestinal disturbances, due to autoantibodies or to aberrant secretion of vasoactive intestinal peptide. Herein we describe a 10-month-old child with neuroblastoma presenting with a complex clinical picture characterized by acute kidney injury manifested by renal insufficiency and signs and symptoms of tubulointerstitial damage, with polyuria, polydipsia, glucosuria, aminoaciduria and hypochloremic metabolic alkalosis, and of glomerular damage with heavy proteinuria. Imaging study documented a suprarenal mass enveloping the aorta and its abdominal and renal ramifications and bilaterally renal veins. This clinical picture shows some analogies with the hyponatremic-hypertensive syndrome concerning the renovascular disease; however, in absence of systemic arterial hypertension, the heavy proteinuria and the polyuria could be explained by sectional increased intraglomerular pressure, due to local renal blood vessels constriction. Hypochloremic metabolic alkalosis probably developed because of local production of renin, responsible of renin-angiotensin-aldosterone system activation, but above all because of chloride loss through sweating. The long lasting dehydration, due to vomiting, sweating and polyuria, caused prolonged prerenal failure evolving in proximal tubular damage manifestations.
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Affiliation(s)
- Giovanni Maria Poggi
- Pediatric Clinic Unit, Department of Sciences for Woman and Child's Health, University of Florence, Florence, Italy
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Peleg H, Bursztyn M, Hiller N, Hershcovici T. Renal artery stenosis with significant proteinuria may be reversed after nephrectomy or revascularization in patients with the antiphospholipid antibody syndrome: a case series and review of the literature. Rheumatol Int 2010; 32:85-90. [DOI: 10.1007/s00296-010-1559-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 07/11/2010] [Indexed: 10/19/2022]
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Candel-Pau J, Castilla-Fernández Y, Madrid-Aris A, Vilalta-Cases R, Lara-Moctezuma LE, García-Peña P, Pérez M, Nieto-Rey JL. Hypertension and segmental renal infarction in children: apropos of two cases. Pediatr Nephrol 2008; 23:841-5. [PMID: 18288504 DOI: 10.1007/s00467-007-0715-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 11/20/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
Abstract
Segmental renal infarction (SRI) is a rare condition that causes renovascular hypertension (RVH), which accounts for 8-10% of all causes of pediatric hypertension. We report the clinical course of two children with idiopathic SRI who suffered severe arterial hypertension associated with hyponatremia. Hypertension was diagnosed during the study of hematuria in the first case and due to a hypertensive emergency in the second case. The etiology was found to be renovascular in both patients, involving the occlusion of small renal arteries and causing SRI. Our first patient was treated with partial nephrectomy, and the second patient was treated with antihypertensive medication given the impossibility of removing the infarcted renal area. The occlusion of small renal arteries is a rare disease of unknown origin in which the gold standard for diagnosis is selective renal arteriography. The definitive treatment is surgical segmentectomy. If segmentectomy is not feasible because of the localization of the infarcted area, as in our second patient, medical treatment is required. In view of the importance of RVH in children and the rareness of the particular etiology here reported (SRI), a review of the literature was done.
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Affiliation(s)
- Júlia Candel-Pau
- Department of Pediatric Nephrology, Hospital Vall d'Hebron, Barcelona, Spain.
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Nicholls MG. Unilateral renal ischemia causing the hyponatremic hypertensive syndrome in children--more common than we think? Pediatr Nephrol 2006; 21:887-90. [PMID: 16773397 DOI: 10.1007/s00467-006-0107-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 01/23/2006] [Indexed: 01/07/2023]
Abstract
A case report in the journal Pediatric Nephrology describes a 15-month-old girl with the syndrome of hypertension and hyponatremia (HH syndrome) due to underlying unilateral renal artery stenosis. This syndrome is typically associated with hypokalemia and severe volume depletion and sometimes proteinuria, all of which, along with hypertension and hyponatremia, are usually corrected by resolution of the underlying renal ischemia. Gross and probably sudden activation of the renin-angiotensin system in response to renal ischemia is central to the pathophysiology although the cardiac atrial and B-type natriuretic peptides probably contribute also. Initial control of the severe hypertension may, in some cases, require careful volume repletion prior to introduction of blockade of the renin-angiotensin system in order to avoid first-dose hypotension, after which correction of the underlying renal ischemia is required. Whereas the syndrome has rarely been reported in children, it is possible that, as in adults, this reflects its lack of recognition by clinicians. The HH syndrome due to unilateral renal ischemia in children may be much more common than we think.
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