Hyponatremic-Hypertensive Syndrome as a Rare Manifestation of Renovascular Hypertension: A Case Series.
Adam Bujanowicz, Aneta Michalczewska, Jakub Pytlos et al.
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Case in brief
Two girls, aged 4 and 9 years, presented with severe hypertension and electrolyte disturbances, including hyponatremia and hypokalemia, with elevated renin-aldosterone activity. Imaging showed renal asymmetry and unilateral right renal artery stenosis due to fibromuscular dysplasia. In the younger child, progressive deterioration and complete arterial occlusion led to nephrectomy, after which hypertension and electrolyte abnormalities resolved. The older child underwent successful percutaneous transluminal renal angioplasty, with normalization of blood pressure, restored renal size symmetry, and sustained remission at 1-year follow-up.
What made this case unusual
The cases illustrate differing outcomes of unilateral renal artery stenosis from fibromuscular dysplasia: complete occlusion required nephrectomy in one child, whereas angioplasty achieved sustained remission in the other.
Diagnostic / clinical pearl
In a child with severe hypertension, hyponatremia, hypokalemia, polyuria, or polydipsia, consider hyponatremic-hypertensive syndrome and investigate for unilateral renal artery stenosis.
Why it matters
The cases show that pediatric renovascular hypertension may require individualized definitive management; nephrectomy or revascularization was followed by resolution or remission in these patients.