Hypertension and nephrology

[Two cases of hyponatremic hypertensive syndrome due to unilateral stenosis of the renal artery]

LAKATOS Orsolya, GYÖRKE Zsuzsanna, VAJDA Péter, JUHÁSZ Zsolt, DEGRELL Péter, SULYOK Endre, MOLNÁR Dénes

SEPTEMBER 20, 2011

Hypertension and nephrology - 2011;15(04)

[Eighty percent of secondary hypertension in childhood is of a renal cause, and ten percent of these cases are due to renovascular disease. Rarely, unilateral stenosis of the renal artery can lead to hyponatremic hypertensive syndrome as a consequence of critical renal ischemia, which is characterized by serious hypertension, electrolyte disturbances (hyponatremia, hypokalemia), polyuria and increased activity of the renin angiotensin aldosterone system. The authors review the cases of a 27-month-old and a 3-year-old boy, in whom HHS developed due to a severe stricture of the renal artery. With the removal of the nonfunctioning kidney, polyuria and electrolyte disturbances resolved, the level of renin normalised, and anti-hypertensive therapy could be gradually ceased. The authors emphasize that the measurement of blood pressure in children is crucial, especially in cases of polyuria, polydipsia, proteinuria and failure to thrive. Early recognition is very important, and a kidney with a function under ten percent must be removed before hypertension can be stabilized. In case of an electrolyte disturbance associated with hypertension, the possibility of hyponatremic hypertensive syndrome must be considered in childhood as well.]

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