Unilateral renal artery stenosis presented with hyponatremic-hypertensive syndrome - case report and literature review

Jhao-Jhuang Ding; Shih-Hua Lin; Jin-Yao Lai; Tai-Wei Wu; Jing-Long Huang; Hung-Tao Chung; Min-Hua Tseng

doi:10.1186/s12882-019-1246-9

Unilateral renal artery stenosis presented with hyponatremic-hypertensive syndrome - case report and literature review

BMC Nephrol. 2019 Feb 21;20(1):64. doi: 10.1186/s12882-019-1246-9.

Authors

Jhao-Jhuang Ding^{1

2}, Shih-Hua Lin³, Jin-Yao Lai⁴, Tai-Wei Wu⁵, Jing-Long Huang⁶, Hung-Tao Chung⁷, Min-Hua Tseng⁸

Affiliations

¹ Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, No 5, Fu-Shing ST., Kwei-Shan, 33305, Taoyuan, Taiwan.
² Department of Pediatrics, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.
³ Division of Nephrology, Department of Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.
⁴ Division of Pediatric Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Linkou, Taiwan.
⁵ Department of Pediatrics, Fetal and Neonatal Institute, Division of Neonatology Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁶ Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
⁷ Division of Cardiology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
⁸ Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, No 5, Fu-Shing ST., Kwei-Shan, 33305, Taoyuan, Taiwan. doc31089@gmail.com.

Abstract

Background: Renal artery stenosis is one of the secondary causes of pediatric hypertension. Cases with critical unilateral renal artery stenosis manifesting with the hyponatremic hypertensive syndrome are rare and a comprehensive description of this disorder in the pediatric population is lacking in the literature.

Case presentation: We describe a 4-year-old boy who presented with severe hypertension, profound hyponatremia, hypokalemia, nephrotic range proteinuria, and polyuria. Distinctly, the diagnosis of hyponatremic hypertensive syndrome secondary to unilateral renal artery stenosis was confirmed in light of laboratory and radiographic findings of severe natriuresis, elevated renin, and unilateral small kidney. Two weeks following nephrectomy, there was resolution of hyponatremia, hypokalemia, nephrotic range proteinuria and hypertension.

Conclusions: Findings of hyponatremia, hypokalemia, hypertension, polyuria, and unilateral renal hypoplasia can be attributed to a unifying pathology of unilateral renal artery stenosis.

Keywords: Hyponatremic-hypertensive syndrome; Renal artery stenosis.

Publication types

Case Reports

MeSH terms

Child, Preschool
Diagnosis, Differential
Female
Humans
Hypertension, Renovascular* / blood
Hypertension, Renovascular* / diagnosis
Hypertension, Renovascular* / physiopathology
Hypertension, Renovascular* / surgery
Hypokalemia / diagnosis
Hypokalemia / etiology
Hyponatremia* / diagnosis
Hyponatremia* / etiology
Kidney* / diagnostic imaging
Kidney* / pathology
Male
Nephrectomy / methods*
Organ Size
Polyuria / diagnosis
Polyuria / etiology
Proteinuria / diagnosis
Proteinuria / etiology
Renal Artery Obstruction* / blood
Renal Artery Obstruction* / diagnosis
Renal Artery Obstruction* / physiopathology
Renal Artery Obstruction* / surgery
Treatment Outcome