Hyponatremic hypertensive syndrome in pediatric patients: is it really so rare?

Kovalski, Yael; Cleper, Roxana; Krause, Irit; Dekel, Benjamin; Belenky, Alexander; Davidovits, Miriam

doi:10.1007/s00467-012-2123-y

Cited by 22 publications

(14 citation statements)

References 15 publications

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“…This case reaffirms the role of renovascular hypertension in massive proteinuria as previously described (2,3,5,(12)(13)(14)(15), as well as in many other case reports, and the resolution of nephrotic syndrome and the renin excess by medical interventions or by revascularization with surgery or angioplasty, and nephrectomy as in our case.…”

Section: Discussionsupporting

confidence: 92%

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Case of Severe Hypertension and Nephrotic Range Proteinuria

et al. 2018

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Section: Discussionsupporting

confidence: 92%

“…However, findings like ours have been described in several case reports, most of them pediatric cases (1)(2)(3)(4)(5). Hyponatremic hypertensive syndrome had been suggested thereof.…”

Section: Case Resolutionsupporting

confidence: 65%

Case of Severe Hypertension and Nephrotic Range Proteinuria

et al. 2018

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“…As we identified three such cases over a span of only 18 mo, we do echo statement by other academicians that this may not be as rare as it is thought to be[3]. …”

Section: Discussionsupporting

confidence: 84%

“…In presence of unilateral renal artery stenosis, angiotensin converting enzyme inhibitors are the preferred medications but this should be avoided if bilateral stenosis is suspected. Revascularization with PTA is the preferred final intervention[1-3,5,9]. …”

Section: Discussionmentioning

confidence: 99%

Hyponatremic hypertensive syndrome - a retrospective cohort study

Mukherjee

Sinha

Akhtar

et al. 2017

WJN

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AIMTo ascertain the frequency of hyponatremic hypertensive syndrome (HHS) in a cohort of children with hypertensive emergency in a tertiary pediatric hospital.METHODSA 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.RESULTSThe 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.CONCLUSIONDespite 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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“…Some other clinical associations with RAS that occurred in this patient and are worth mentioning are the nephrotic range proteinuria and hyponatremic hypertensive syndrome, both of which have been described in the literature [31,32]. The histology of the kidney in patients with RAS, nephrotic syndrome, and hyperreninemia who underwent nephrectomy for uncontrolled hypertension have shown severe foot process effacement [33].…”

Section: Discussionmentioning

confidence: 62%

Efficacy of Antihypertensive Therapy in a Child with Unilateral Focal Fibromuscular Dysplasia of the Renal Artery: A Case Study and Review of Literature

2020

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Background: Fibromuscular dysplasia (FMD) is one of the important etiologies of renovascular hypertension in children. It is usually resistant to multiple antihypertensive agents and can cause extreme elevation in blood pressures, which can lead to end organ damage if not promptly diagnosed and treated. Treatment options include medical management with antihypertensive agents, balloon or stent angioplasties, surgical revascularization, and nephrectomy. The aim of the study was to review the efficacy of antihypertensive therapy only in the management of FMD in a very young child. Methods: This is a retrospective chart study with review of literature. Results: Here, we report a 22-month-old toddler who presented with severe resistant hypertension and cardiomyopathy who was found to have focal FMD of the right renal artery. She also presented with proteinuria, hyponatremia that was probably secondary to pressure natriuresis, hypokalemia, hyperaldosteronism, and elevated plasma renin activity. The stabilization of blood pressures was done medically with the usage of antihypertensive medications only, without the need for angioplasty or surgical revascularization. Conclusions: We demonstrate that surgical intervention may not always be necessary in the treatment of all cases of FMD, especially in a small child where such intervention may be technically challenging and lead to potential complications. Hence, medical management alone may be sufficient, at least for the short-term, in small children with controlled hypertension and normal renal function, with surgical intervention reserved for FMD with medication-refractory hypertension and/or compromised renal function.

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Hyponatremic hypertensive syndrome in pediatric patients: is it really so rare?

Abstract: 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.

Cited by 22 publications

References 15 publications

Case of Severe Hypertension and Nephrotic Range Proteinuria

Case of Severe Hypertension and Nephrotic Range Proteinuria

Hyponatremic hypertensive syndrome - a retrospective cohort study

Efficacy of Antihypertensive Therapy in a Child with Unilateral Focal Fibromuscular Dysplasia of the Renal Artery: A Case Study and Review of Literature

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