ESPN 51th Annual Meeting

ESPN 2018


 
An Uncommon Presentation of Renovascular Hypertension: Polyuria and Polydipsia
HULYA NALCACIOGLU 1 FUNDA BASTUG 1 ALI KOC 2 SIBEL YEL 1

1- KAYSERI TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY, TURKEY
2- KAYSERI TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF RADIOLOGY, TURKEY
 
Introduction:

 Renovascular hypertension is the most common form of secondary hypertension, and symptoms may be associated with the activation of the renin– angiotensin system (RAS) by the renal arterial stenosis. The common presenting symptoms are headache, confusion or seizure but the presenting features vary and sometimes it can be asymptomatic. In this study, we present a 5-year-old boy who came to us with polyuria and polydipsia for evaluation and on clinical and laboratory examination, he was noted to have high blood pressure and hypokalemic metabolic alkalosis. Following investigations revealed renovascular hypertension due to renal artery stenosis.  

Material and methods:

 A 5-year-old boy was referred with a history of polyuria, polydipsia of 3-month duration. He was apparently healthy till the onset of these symptoms. The family history was unremarkable. On physical examination, his weight was 26 kg (25th-50th centile) and height was 103 cm (25th-50th centile) and blood pressure on several measurements was above the 95th percentile for his age and height (160/100 mm hg). There was no clinical evidence of coarctation, neurofibromatosis, organomegaly or renal bruit. Laboratory results revealed mild hypokalemia (K:3meq/L), metabolic alkalosis (p:7.43 HCO3:30), elevated peripheral renin activity (renin: 55 ng/ml/hour (0.5-1.9), and increase in aldosterone (222 pg/ml) levels. Renal Ultrasonography showed a small left kidney. Three dimensional CT angiography showed an occlusion of the left renal artery. Echocardiogram revealed concentric left ventricular hypertrophy supporting the presence of undetected hypertension. Ophthalmic assessment was normal.  

Results:

 On admission, a nicardipine hydrochloride drip was started in order to maintain the blood pressure. After starting oral administration of enalapril, propranolol hydrochloride and doxazosin in addition to the nicardipine, the systolic blood pressure was stabilized. The angiogram revealed severe occlusion of the left renal artery making it impossible to perform percutaneous transluminal renal artery angioplasty. With the use of antihypertensive drugs, blood pressure normalized, the symptoms and laboratory findings were improved.

Conclusions:

 Polyuria and polydipsia are rare symptoms of Renovascular hypertension.  Complete physical examination prevented unnecessary investigations for polyuria and led to a correct diagnosis.