Hyponatremic hypertensive syndrome (HHS) in an 18-month old-child presenting as malignant hypertension: Case report

Mehul P. Dixit, John D Hughes, Andreas A Theodorou, Naznin M. Dixit

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: The combination of hyponatremia and renovascular hypertension is called hyponatremic hypertensive syndrome (HHS). Malignant hypertension as a presentation has been reported in adults with HHS but is rare in children. Case Presentation: An eighteen month-old male presented with drowsiness, sudden onset status epilepticus and blood pressure of 210/160. The electrolytes on admission revealed sodium of 120 mEq/L and potassium of 2.1 mEq/L. The peripheral renin activity (PRA) was 172 ng/ml/min (normal 3-11 ng/ml/min) and serum aldosterone level was 91 ng/dl (normal 4 to 16 ng/dl). Patient underwent angioplasty with no success, followed by surgical correction. Two years since the diagnosis, the blood pressure is controlled with labetolol and amlodipine (at less than sixth of the pre-operative dosages). The PRA is 2.4 ng/ml/min and aldosterone 15.5 ng/dl. The child not only had three renal arteries on left but all of them were stenosed which to best of our knowledge has not been described. Conclusion: As uncommon as HHS with malignant hypertension may be in adults it is under-reported in children and purpose of the case report is to raise its awareness.

Original languageEnglish (US)
Article number5
JournalBMC Nephrology
Volume5
DOIs
StatePublished - Apr 27 2004

Fingerprint

Malignant Hypertension
Aldosterone
Renin
Blood Pressure
Labetalol
Amlodipine
Renovascular Hypertension
Hyponatremia
Status Epilepticus
Sleep Stages
Renal Artery
Angioplasty
Electrolytes
Potassium
Sodium
Serum

ASJC Scopus subject areas

  • Medicine(all)
  • Nephrology

Cite this

Hyponatremic hypertensive syndrome (HHS) in an 18-month old-child presenting as malignant hypertension : Case report. / Dixit, Mehul P.; Hughes, John D; Theodorou, Andreas A; Dixit, Naznin M.

In: BMC Nephrology, Vol. 5, 5, 27.04.2004.

Research output: Contribution to journalArticle

@article{010f83dcfbdf4ac58ff75256384a746c,
title = "Hyponatremic hypertensive syndrome (HHS) in an 18-month old-child presenting as malignant hypertension: Case report",
abstract = "Background: The combination of hyponatremia and renovascular hypertension is called hyponatremic hypertensive syndrome (HHS). Malignant hypertension as a presentation has been reported in adults with HHS but is rare in children. Case Presentation: An eighteen month-old male presented with drowsiness, sudden onset status epilepticus and blood pressure of 210/160. The electrolytes on admission revealed sodium of 120 mEq/L and potassium of 2.1 mEq/L. The peripheral renin activity (PRA) was 172 ng/ml/min (normal 3-11 ng/ml/min) and serum aldosterone level was 91 ng/dl (normal 4 to 16 ng/dl). Patient underwent angioplasty with no success, followed by surgical correction. Two years since the diagnosis, the blood pressure is controlled with labetolol and amlodipine (at less than sixth of the pre-operative dosages). The PRA is 2.4 ng/ml/min and aldosterone 15.5 ng/dl. The child not only had three renal arteries on left but all of them were stenosed which to best of our knowledge has not been described. Conclusion: As uncommon as HHS with malignant hypertension may be in adults it is under-reported in children and purpose of the case report is to raise its awareness.",
author = "Dixit, {Mehul P.} and Hughes, {John D} and Theodorou, {Andreas A} and Dixit, {Naznin M.}",
year = "2004",
month = "4",
day = "27",
doi = "10.1186/1471-2369-5-5",
language = "English (US)",
volume = "5",
journal = "BMC Nephrology",
issn = "1471-2369",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Hyponatremic hypertensive syndrome (HHS) in an 18-month old-child presenting as malignant hypertension

T2 - Case report

AU - Dixit, Mehul P.

AU - Hughes, John D

AU - Theodorou, Andreas A

AU - Dixit, Naznin M.

PY - 2004/4/27

Y1 - 2004/4/27

N2 - Background: The combination of hyponatremia and renovascular hypertension is called hyponatremic hypertensive syndrome (HHS). Malignant hypertension as a presentation has been reported in adults with HHS but is rare in children. Case Presentation: An eighteen month-old male presented with drowsiness, sudden onset status epilepticus and blood pressure of 210/160. The electrolytes on admission revealed sodium of 120 mEq/L and potassium of 2.1 mEq/L. The peripheral renin activity (PRA) was 172 ng/ml/min (normal 3-11 ng/ml/min) and serum aldosterone level was 91 ng/dl (normal 4 to 16 ng/dl). Patient underwent angioplasty with no success, followed by surgical correction. Two years since the diagnosis, the blood pressure is controlled with labetolol and amlodipine (at less than sixth of the pre-operative dosages). The PRA is 2.4 ng/ml/min and aldosterone 15.5 ng/dl. The child not only had three renal arteries on left but all of them were stenosed which to best of our knowledge has not been described. Conclusion: As uncommon as HHS with malignant hypertension may be in adults it is under-reported in children and purpose of the case report is to raise its awareness.

AB - Background: The combination of hyponatremia and renovascular hypertension is called hyponatremic hypertensive syndrome (HHS). Malignant hypertension as a presentation has been reported in adults with HHS but is rare in children. Case Presentation: An eighteen month-old male presented with drowsiness, sudden onset status epilepticus and blood pressure of 210/160. The electrolytes on admission revealed sodium of 120 mEq/L and potassium of 2.1 mEq/L. The peripheral renin activity (PRA) was 172 ng/ml/min (normal 3-11 ng/ml/min) and serum aldosterone level was 91 ng/dl (normal 4 to 16 ng/dl). Patient underwent angioplasty with no success, followed by surgical correction. Two years since the diagnosis, the blood pressure is controlled with labetolol and amlodipine (at less than sixth of the pre-operative dosages). The PRA is 2.4 ng/ml/min and aldosterone 15.5 ng/dl. The child not only had three renal arteries on left but all of them were stenosed which to best of our knowledge has not been described. Conclusion: As uncommon as HHS with malignant hypertension may be in adults it is under-reported in children and purpose of the case report is to raise its awareness.

UR - http://www.scopus.com/inward/record.url?scp=2942608999&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=2942608999&partnerID=8YFLogxK

U2 - 10.1186/1471-2369-5-5

DO - 10.1186/1471-2369-5-5

M3 - Article

C2 - 15113447

AN - SCOPUS:2942608999

VL - 5

JO - BMC Nephrology

JF - BMC Nephrology

SN - 1471-2369

M1 - 5

ER -