Sodium loss as leading symptom of renovascular hypertension in the newborn

Rosendahl, W; Ranke, M. B.; Mentzel, HJ

doi:10.1007/bf01477054

Cited by 9 publications

(14 citation statements)

References 10 publications

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“…Vomiting is common and could contribute considerably to the electrolyte disturbances whilst exacerbating volume depletion. In children and neonates, presenting features are polydipsia, polyuria or enuresis, weight loss and volume depletion, drowsiness, and, as in adults, various neurological and behavioral signs and symptoms [7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…It seems, however, that the HH syndrome secondary to unilateral renal ischemia in children has been documented as case reports involving only one or two patients [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Indeed, most reported discussions of renovascular disease in the pediatric age group make little or no mention of the HH syndrome [38].…”

Section: Managementmentioning

confidence: 99%

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Unilateral renal ischemia causing the hyponatremic hypertensive syndrome in children—more common than we think?

Nicholls

2006

Pediatr Nephrol

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A case report in the journal Pediatric Nephrology describes a 15-month-old girl with the syndrome of hypertension and hyponatremia (HH syndrome) due to underlying unilateral renal artery stenosis. This syndrome is typically associated with hypokalemia and severe volume depletion and sometimes proteinuria, all of which, along with hypertension and hyponatremia, are usually corrected by resolution of the underlying renal ischemia. Gross and probably sudden activation of the renin-angiotensin system in response to renal ischemia is central to the pathophysiology although the cardiac atrial and B-type natriuretic peptides probably contribute also. Initial control of the severe hypertension may, in some cases, require careful volume repletion prior to introduction of blockade of the renin-angiotensin system in order to avoid first-dose hypotension, after which correction of the underlying renal ischemia is required. Whereas the syndrome has rarely been reported in children, it is possible that, as in adults, this reflects its lack of recognition by clinicians. The HH syndrome due to unilateral renal ischemia in children may be much more common than we think.

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Section: Clinical Featuresmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Unilateral renal ischemia causing the hyponatremic hypertensive syndrome in children—more common than we think?

Nicholls

2006

Pediatr Nephrol

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“…This has previously been observed in adults and in two fullterm neonates with severe arterial hypertension [5,6]. The first newborn infant presented with severe dehydration and hyponatremia with marked hypertension (systolic blood pressure 180 -210 mmHg) due to unilateral thrombosis of the renal artery.…”

Section: Discussionmentioning

confidence: 54%

“…Arterial hypertension may cause a wide range of non-specific clinical symptoms in neonates, including water and sodium wasting [3]. Increased water and sodium urinary losses may led to severe dehydration, which have previously been reported in only two term neonates with renovascular hypertension [5,6]. We report three preterm infants, free of diuretic therapy, in whom arterial hypertension caused hyponatremic dehydration due to polyuria and increased natriuresis.…”

Section: Introductionmentioning

confidence: 77%

Salt depletion and dehydration in hypertensive preterm infants

et al. 1997

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Three preterm infants presented with both severe or moderate arterial hypertension and dehydration due to increased water and sodium urinary excretion. In patient 1, water and sodium wasting were extremely severe and peaked at 575 ml/kg per day and 73 mEq/kg per day, respectively. In all infants, urinary water and sodium excretion dramatically decreased when hypertension resolved. The overall clinical data suggest a pressure natriuresis phenomenon.

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“…[11][12][13] The pathogenesis in the present case most probably was the outcome of a number of different factors acting together, rather than any one single factor.…”

Section: Discussionmentioning

confidence: 99%

Hyponatremic-Hypertensive Syndrome Associated With Renovascular Hypertension. A Case Report.

Tetsuou

Miyatake

Tanaka

et al. 2002

Circ J

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enovascular hypertension is the most common form of secondary hypertension, and multiple additional symptoms may be associated with the activation of the renin -angiotensin system (RAS) by the renal arterial stenosis, including severe electrolyte disorders and albuminuria. We discuss a case of renovascular hypertension in which severe hypokalemia and hyponatremia also developed. Case ReportA 49-year-old unmarried man was admitted to hospital in November 1994 because of severe hyponatremia, hypokalemia and uncontrolled hypertension. Both of his parents had had hypertension and died from stroke. He smoked 20 cigarettes and drank 700 ml of sake daily. He had had acute pancreatitis at age 42. Five days before admission, the patient presented at the Outpatient Clinic of the hospital complaining of general malaise lasting 1 week. His blood pressure was 220/118 mmHg, and serum sampled at the time of presentation showed the following electrolyte concentrations: K + 2.2 mmol/L, Na + 117 mmol/L, Cl -117 mmol/L. He was hospitalized for further evaluation.At hospitalization, the patient's blood pressure was again 220/118 mmHg, the pulse was regular, and no pallor or jaundice was present. The optic fundi showed exudates, focal hemorrhage, and arteriovenous nicking. Otherwise, the head, neck, heart and lungs were normal. No abdominal bruit or peripheral edema was present. The daily urine Circulation Journal Vol.66, March 2002volume was 4,900 ml.The white blood cell count was 10,600 /mm 3 , but there was nothing remarkable in the differential count. Laboratory findings are summarized in Tables 1 and 2. Hypercholesterolemia (278 mg/dl) and fasting hyperglycemia (200 mg/dl) were present. Serum electrolyte concentrations included Na + 112 mmol/L, K + 2.1 mmol/L, and Cl -63 mmol/L, but the concentrations of Na + and K + in the urine were normal. Albumin was detected in the urine. Analysis of arterial blood gases while the patient breathed room air indicated metabolic alkalosis (pH 7.54, base excess 12 mmol/L, and plasma bicarbonate, 36.1 mmol/L). Serum and urine osmolalities were hypotonic. Renal function testing indicated that the 24-h creatinine clearance was significantly decreased (45 ml/min), and the Fishberg and phenolsulfonphtalein tests showed that his urine concentrating ability and proximal renal tubular excretion were impaired. Plasma renin activity and aldosterone, vasopressin, angiotensin-I and -II, and cathecolamine secretion were all increased. Abdominal ultrasonography disclosed atrophy of the right kidney; abdominal computed tomography and magnetic resonance imaging (Fig 1) showed atrophy of the right kidney and an abdominal aortic aneurysm at the origin of the right renal artery, presumed to be causing the reduced renal blood flow. Renal scintigraphy (Fig 2) showed reduced uptake by the right kidney, and delayed excretion by the left kidney. Arteriography demonstrated right renal arterial stenosis associated with a saccular aortic aneurysm 3 cm in diameter involving the right side of the aorta at the origin of th...

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Sodium loss as leading symptom of renovascular hypertension in the newborn

Cited by 9 publications

References 10 publications

Unilateral renal ischemia causing the hyponatremic hypertensive syndrome in children—more common than we think?

Unilateral renal ischemia causing the hyponatremic hypertensive syndrome in children—more common than we think?

Salt depletion and dehydration in hypertensive preterm infants

Hyponatremic-Hypertensive Syndrome Associated With Renovascular Hypertension. A Case Report.

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