1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Tsuchida T, Yano H, Raita Y, Kinjo M. Nephrotic range proteinuria and metabolic alkalosis in Takayasu arteritis. BMJ Case Rep 2019; 12:12/4/e228637. [PMID: 30992286 DOI: 10.1136/bcr-2018-228637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nephrotic range proteinuria and metabolic alkalosis are unusual findings in large vessel vasculitis. In this case, renovascular hypertension with unilateral renal artery stenosis in Takayasu arteritis was complicated by nephrotic range proteinuria. Symptoms resolved after angioplasty, although non-nephrotic proteinuria persisted. The renal pathology of Takayasu arteritis included focal glomerulosclerosis.
Collapse
Affiliation(s)
- Takahiro Tsuchida
- Department of Internal Medicine, Okinawa Chubu Hospital, Uruma, Japan
| | - Hiroyuki Yano
- Department of Internal Medicine, Okinawa Chubu Hospital, Uruma, Japan
| | - Yoshihiko Raita
- Department of Internal Medicine, Okinawa Chubu Hospital, Uruma, Japan
| | - Mitsuyo Kinjo
- Department of Internal Medicine, Okinawa Chubu Hospital, Uruma, Japan
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Hyponatremic-Hypertensive Syndrome in Ovarian Paraganglioma. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
6
|
Jerónimo M, Dionísio T, Gomes C, Neves JF. Renovascular hypertension: a case with atypical neurological signs. BMJ Case Rep 2015; 2015:bcr-2014-208336. [PMID: 26351310 DOI: 10.1136/bcr-2014-208336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Secondary hypertension is the most frequent form of hypertension in children. Renovascular disease accounts for 5-10% of all childhood hypertension and should be suspected in the presence of severe hypertension found difficult to manage with medical therapy. Uncontrolled hypertension can lead to severe target organ damage. We describe the case of a 13-month-old baby boy with failure to thrive, recent muscular weakness of the lower extremities and irritability. Hypertension was detected and he was admitted to the paediatric intensive care unit with a refractory hypertensive emergency, despite multiple antihypertensive therapies. Bilateral renal artery stenosis was diagnosed through renal angiography and balloon dilation was performed, leading to lower blood pressure. He is currently withdrawing from antihypertensive medication, and slowly gaining weight and recovering from target organ damage. However, weakness of the lower extremities persists and he has been diagnosed with a neurogenic bladder.
Collapse
Affiliation(s)
| | - Teresa Dionísio
- Pediatric Intensive Care Unit, Hospital Pediátrico de Coimbra, Coimbra, Portugal
| | - Clara Gomes
- Department of Paediatric Nephrology, Hospital Pediátrico de Coimbra, Coimbra, Portugal
| | - José Farela Neves
- Pediatric Intensive Care Unit, Hospital Pediátrico de Coimbra, Coimbra, Portugal
| |
Collapse
|
7
|
Parikh P, Duhame D, Monahan L, Woroniecki R. Renal artery stenosis precipitates hyponatremic hypertensive syndrome and posterior reversible leukoencephalopathy. Front Pediatr 2015; 3:40. [PMID: 26000267 PMCID: PMC4423501 DOI: 10.3389/fped.2015.00040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/20/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hyponatremic hypertensive syndrome (HHS) is an uncommon disorder usually encountered in the adult population with unilateral renal artery stenosis and is under-recognized in the pediatric population. CASE DIAGNOSIS/TREATMENT A 19-month-old male presented with new-onset status epilepticus associated with neurological sequelae, and hypertension to a high of 248/150 mmHg. Lab work revealed significant hyponatremia, elevated peripheral renin activity, and increase in aldosterone and ADH levels. A diagnosis of HHS was made. Initial analysis revealed a high-grade proximal renal artery stenosis by magnetic resonance imaging (MRI) and angiogram. Electroencephalogram and an MRI of the brain demonstrated characteristic abnormalities of the left temporal-parietal regions consistent with posterior reversible leukoencephalopathy syndrome (PRES). The patient responded to right renal artery balloon dilation and stent placement. Since intervention and close blood pressure control with Amlodipine, the patient has been free of seizures and is neurologically intact. CONCLUSION We report a case of malignant hypertension in a 19-month-old male secondary to renal artery stenosis with associated HHS and PRES. Prognosis of PRES in children with renal disease is excellent. Prompt intervention may offer near complete resolution of physiologic and symptomatic effects of HHS and PRES due to high-grade renal artery stenosis. This report was written with parental consent for de-identified case presentation and radiographs for the educational benefit of other medical professionals.
Collapse
Affiliation(s)
- Pranav Parikh
- Department of Pediatrics, Stony Brook University School of Medicine , Stony Brook, NY , USA
| | - Danielle Duhame
- Department of Pediatrics, Stony Brook University School of Medicine , Stony Brook, NY , USA
| | - Laura Monahan
- Department of Pediatrics, Stony Brook University School of Medicine , Stony Brook, NY , USA
| | - Robert Woroniecki
- Department of Pediatrics, Stony Brook University School of Medicine , Stony Brook, NY , USA
| |
Collapse
|