The hyponatremic hypertensive syndrome in renal artery stenosis

Wl, Browne; Nair, Balakrishnan R

doi:10.4103/0022-3859.30327

Cited by 11 publications

(11 citation statements)

References 8 publications

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“…This is in fact the hyponatremia-hypertension syndrome [3][4][5]16], which is due to multiple factors promoting sodium depletion in the presence of underlying unilateral renal stenosis. The main factor is the activation of the renin-angiotensin system and the pressure renal loss from the nonstenotic kidney [2], with sodium depletion and polyuria.…”

Section: Discussionmentioning

confidence: 98%

Hypertension and segmental renal infarction in children: apropos of two cases

Candel-Pau¹,

Castilla-Fernández²,

Madrid³

et al. 2008

Pediatr Nephrol

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Segmental renal infarction (SRI) is a rare condition that causes renovascular hypertension (RVH), which accounts for 8-10% of all causes of pediatric hypertension. We report the clinical course of two children with idiopathic SRI who suffered severe arterial hypertension associated with hyponatremia. Hypertension was diagnosed during the study of hematuria in the first case and due to a hypertensive emergency in the second case. The etiology was found to be renovascular in both patients, involving the occlusion of small renal arteries and causing SRI. Our first patient was treated with partial nephrectomy, and the second patient was treated with antihypertensive medication given the impossibility of removing the infarcted renal area. The occlusion of small renal arteries is a rare disease of unknown origin in which the gold standard for diagnosis is selective renal arteriography. The definitive treatment is surgical segmentectomy. If segmentectomy is not feasible because of the localization of the infarcted area, as in our second patient, medical treatment is required. In view of the importance of RVH in children and the rareness of the particular etiology here reported (SRI), a review of the literature was done.

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Section: Discussionmentioning

confidence: 98%

Hypertension and segmental renal infarction in children: apropos of two cases

Candel-Pau¹,

Castilla-Fernández²,

Madrid³

et al. 2008

Pediatr Nephrol

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“…He had specific requirements for successful repairs, such as being applicable to all degrees of the deformity, creating a new urethra large enough for the passage of a cystoscope, and that the urethra should not be made of hairy skin [ Table 1]. He felt strongly that the urine should be diverted from the site of the repair during healing and that the operation should not be too complicated for the average competent surgeon to perform with a high degree of success [12,13]. Many of the principles Denis Browne stated are used in hypospadias repair today.…”

Section: Hypospadias Repairmentioning

confidence: 98%

“…This was his theory of congenital deformities of mechanical origin, which covered many congenital orthopedic abnormalities, particularly talipes equino varus, from Table 1 Requirements for a successful hypospadias operation as stated by Denis Browne [13]. 1 It should be applicable to all degrees of the deformity 2…”

Section: Medical Contributions Orthopedicsmentioning

confidence: 99%

“…The width of ventral penile skin used was 2/3 the desired circumference of the urethra. Skin flaps were raised on either side and scrotal incisions were made to allow free egress of blood and serum [13]. He used multiple relaxing incisions both ventrally in the scrotum but, most importantly, dorsally to aid in a tension-free repair.…”

Section: Hypospadias Repairmentioning

confidence: 99%

“…He used multiple relaxing incisions both ventrally in the scrotum but, most importantly, dorsally to aid in a tension-free repair. The ventral skin was then reapproximated without tension using double stop sutures with glass beads [13]. The glass beads were atraumatic to the reapproximated skin edges and helped remove any tension on the catgut suture [ Fig.…”

Section: Hypospadias Repairmentioning

confidence: 99%

See 2 more Smart Citations

Sir Denis Browne: Contributions to Pediatric Urology

Patel

Caldamone

2010

Journal of Pediatric Urology

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Diagnostic approach and management of inpatient hyponatremia

Palmer

2010

Journal of Hospital Medicine

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Hyponatremia is one of the most common electrolyte abnormalities encountered in clinical practice. The frequency of the disorder varies according to definition and clinical setting but has been reported to be present in 28% of patients upon hospital admission and in 7% of patients attending an ambulatory community clinic. 1 Increasing age, medications, various disease states, and administration of hypotonic fluids are among the known risk factors for the disorder.The mortality rate in hyponatremic patients is approximately 3 times that of normonatremic hospitalized patients. [2][3][4][5] Outcomes are particularly poor in those patients whose serum sodium (Na þ ) falls during a hospitalization. In 1 prospective study the mortality rate in patients with a normal serum Na þ concentration was 0.2% in comparison to a mortality rate of 11.2% and 25% in patients with a serum Na þ concentration <130 mEq/L and <120 mEq/L, respectively. 2 In a recent retrospective cohort study of 10,899 hospitalized patients, the incidence of hyponatremia (<135 mmol/L) at admission was 5.5%. 5 As compared to those with normonatremia, these patients were more likely to require intensive care and mechanical ventilation within 48 hours of hospitalization. In addition, hospital mortality, mean length of stay, and costs were significantly greater among patients with hyponatremia than those without.The association with hyponatremia and adverse outcomes could be the direct result of hyponatremia, the comormidities that lead to the electrolyte derangement, or both. Whatever the mechanism, hyponatremia should not be viewed as an innocuous condition. Rather, clinicians should view this disorder with urgency and institute measures to prevent any further decline in the serum Na þ concentration and initiate appropriate therapy for its correction. This review will first briefly summarize the pathogenesis of hyponatremia and then discuss various disease states encountered in the hospital setting in which hyponatremia is frequently present. Pathogenesis of HyponatremiaHyponatremia is generally associated with a hypoosmolar state and is a marker for a disturbance in water balance. Stated differently, all hyponatremia is dilutional. The approach to the patient with hyponatremia is outlined in Figure 1. Is the Hyponatremia Representative of a Hypoosmolar State?There are 3 causes of hyponatremia in which it is not associated with a hypoosmolar state. The first of these is pseudohyponatremia which involves an abnormal measurement of the serum Na þ . This occurs in patients with hyperglobulinemia or hypertriglyceridemia in whom plasma water relative to plasma solids is decreased in blood, leading to less Na þ in a given volume of blood. In general, this problem is becoming less prevalent as many laboratories are using Na þ electrodes without diluting the blood such that the Na þ measurement becomes independent of plasma water and nonaqueous contents.A second cause of hyponatremia in the absence of a hypoosmolar state involves true hyponatremia but with elevati...

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The hyponatremic hypertensive syndrome in renal artery stenosis

Cited by 11 publications

References 8 publications

Hypertension and segmental renal infarction in children: apropos of two cases

Hypertension and segmental renal infarction in children: apropos of two cases

Sir Denis Browne: Contributions to Pediatric Urology

Diagnostic approach and management of inpatient hyponatremia

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