Hypertension and Hydronephrosis: Rapid Resolution of High Blood Pressure Following Relief of Bilateral Ureteric Obstruction

Abstract

Hypertension secondary to hydronephrosis is not commonly reported in the medical literature. Tubuloglomerular feedback and the renin-angiotensin-aldosterone axis are thought to mediate this process. We describe a patient presenting with acute kidney injury and bilateral hydronephrosis secondary to pelvic malignancy in which peripheral venous renin and aldosterone were elevated. Her blood pressure improved rapidly following insertion of bilateral nephrostomies. The speed of resolution of hypertension following relief of obstruction suggests that humorally mediated vasoconstriction can play an important role in the mechanism by which hydronephrosis causes hypertension. We also discuss other causes of renal parenchymal compression that may lead to the development of hypertension.

Bilateral Obstructive Uropathy Caused by Congenital Bladder Diverticulum Presenting as Hypertensive Retinopathy

“…Secondary hypertension caused by hydronephrosis has been described in an animal model, 15 but is not commonly reported in medical literature. 16 17 In the hydronephrotic condition, the pathologically increased tubuloglomerular feedback system and the increased activity of renin-angiotension-aldosterone system contribute to the development of hypertension. 15 18 …”

“…Complete blood count (CBC) showed low hemoglobin of 12.8 g/dL, normal hematocrit of 39.2%, and normal white blood cell (WBC) count of 7,200/µL. Blood chemistry showed increased blood urea nitrogen (BUN) of 20.5 mg/dL (reference 7 8 9 10 11 12 13 14 15 16 17 18 ), creatinine of 1.66 mg/dL (0.50–1.06), and uric acid of 9.9 mg/dL (2.5–8.3), meaning decreased renal function. Although the serum aldosterone-to-renin ratio of 4.04 in the supine position did not increase, the serum renin activity of 5.45 ng/mL/hr (supine 0.30–2.90) and the aldosterone level of 22.06 ng/dL (supine 1.0–10.5) were elevated simultaneously.…”

Symptomatology and Clinic of Hydronephrosis Associated With Uretero Pelvic Junction Anomalies

“…Published pediatric reports of hypertension obviously caused by hydronephrosis are few, and the numbers of patients included in these reports are very low (63)(64)(65)(66)(67)(68). On clinical basis, the number of cases diagnosed with UPJHN/UPJO by referring to the results or symptoms of high blood pressure in the child age group is very few.…”

Hydronephrosis and risk of later development of hypertension

“…Most children with hydronephrosis are not reported to be hypertensive, but there are several case reports of patients who became normotensive after relief of the obstruction by either nephrectomy or pyeloplasty, e.g. . Currently, there are few small clinical studies that have investigated the changes in blood pressure following surgical management of hydronephrosis in children, and hence large prospective clinical trials are warranted to determine the best treatment policy.…”