Multimodal imaging approach in hyponatremic hypertensive syndrome. A rare case of pediatric unilateral hypoplasia of the main renal artery combined itself with stenosis and review of literature

Radiology Case Reports

article

Angela Siervo¹  Anna Castaldo¹  Daniela Furlan¹  Dolores Ferrara¹  Eugenio Rossi¹  Domenico Noviello¹  Massimo Zeccolini¹  Francesco Esposito¹ 

[1] Advanced Biomedical Sciences Department, University Federico II of Naples

关键词: Renovascular hypertension;    Hyponatremic hypertensive syndrome;    Hypoplasia;    Ultrasound;    Computed tomography angiography;    Angioplasty;   

DOI  :  10.1016/j.radcr.2022.10.034

学科分类：生物化学工程

来源: University of Washington * Department of Radiology

【 摘 要 】

Renal artery stenosis (RAS) accounts for approximately 5%-10% of secondary renovascular hypertension in the pediatric population. It can occur as an isolated entity, or as a hypoplasia combined itself with stenosis. Hypoplasia, or long-segment developmental narrowing, is a rare cause of renovascular hypertension. Hyponatremic hypertensive syndrome (HHS) is a malignant complication of unilateral RAS and/or renal artery hypoplasia. Hyponatremia, hypokalemic hypochloremic metabolic alkalosis, nephrotic range proteinuria, polyuria, polydipsia, and weight loss are the most common findings. In particular, hypertension remains refractory despite aggressive antihypertensive therapy. Laboratory findings of elevated plasma levels of renin in most case suggest that the stimulation of renin release from the ischemic kidney plays an important pathophysiologic role. HHS is a diagnostic and therapeutic challenge in children. We report a case of a unilateral right renal artery hypoplasia, complicated by a segmental narrowing, in a 17-month-old male, clinically symptomatic for hypertension. We emphasize the role of ultrasound, computed tomography, and digital subtraction angiography that should be planned as reliable and non-invasive multimodal imaging approach.

【 授权许可】

CC BY|CC BY-NC-ND