Two cases of hyponatremic-hypertensive syndrome in childhood with renovascular hypertension

Abstract

Both patients showed rapidly progressive renovascular hypertension and loss of function of the affected kidney. In order to preserve renal function in such cases, early invasive intervention appears to be necessary.

Diagnostic and medical strategy for renovascular hypertension: report from a monocentric pediatric cohort

“…In our study, two patients presented with hyponatremic hypertensive syndrome, which is rare in children [2,23]. Therefore, while electrolyte disturbances must be screened to exclude other causes of hypertension such as monogenic etiologies, they are not a sensitive marker for the diagnosis of renovascular hypertension.…”

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

“…Although initially considered a rare condition, HHS has been identified in approximately 16% of adults with unilateral renal artery stenosis [4,10]. Data on the pediatric population are still sparse [5][6][7][8][9][10][11]. In an editorial commentary, Nicholls [2] suggested that HHS may be underdiagnosed in children and probably more common than previously thought.…”

“…All of these changes, along with the sodium depletion secondary to pressure natriuresis, cause hyponatremia. The pressure-induced hyperfiltration and natriuresis might be responsible for the hypercalciuria and hyperuricosuria, while the proteinuria may be secondary to hyperfiltration due to the proteinuric effect of angiotensin II and, probably, atrial natriuretic peptide [2,9,10,[13][14][15]. Accordingly, for HHS to occur, the stenosis of the renal artery must be unilateral, and perfusion and function of the contralateral kidney must be normal [9,13].…”

“…Renovascular hypertension is responsible for 5-25% of cases of secondary hypertension in children, and fibromuscular dysplasia accounts for up to 60% of cases [9,10]. Renal artery stenosis may be due to external compression [5].…”

“…All presented with severe hypertension, thirst, polyuria, weight loss, confusion, and hyponatremia. HHS has been described in children as well [5][6][7][8][9][10][11][12][13], starting with the report of Blanc et al [5] in 1991. Laboratory findings of elevated plasma levels of renin in most cases suggest that the stimulation of renin release from the ischemic kidney plays an important pathophysiologic role.…”