Renovascular hypertension: a case with atypical neurological signs

Abstract

SUMMARYSecondary 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. BACKGROUND

An unusual cause of renovascular hypertension in a pediatric patient with chronic kidney disease

“…Jeronimo et al reported a case of a 13-month-old baby with severe RVH (bilateral renal artery stenosis) that manifested with failure to thrive, recent muscular weakness of the lower extremities, and irritability. In the authors' opinion, the patient was diagnosed with a neurogenic bladder that was most probably caused by medullary infarction caused by severe hypertension [29]. In the presented case, due to renal function, blood pressure stabilization, and extremely difficult surgical conditions and access, the patient was treated conservatively.…”