Peer-review started: June 11, 2016
First decision: July 11, 2016
Revised: August 29, 2016
Accepted: October 25, 2016
Article in press: October 27, 2016
Published online: January 6, 2017
Processing time: 200 Days and 4 Hours
To ascertain the frequency of hyponatremic hypertensive syndrome (HHS) in a cohort of children with hypertensive emergency in a tertiary pediatric hospital.
A retrospective review was undertaken among children with hypertensive emergency admitted in our tertiary children hospital between June 2014 and December 2015 with an aim to identify any children with HHS. Three children with HHS were identified during this period.
The 3 patients with HHS presented with hypertensive emergency. They were initially managed with Labetalol infusion and thereafter switched to oral anti-hypertensives (combination of Nifedipine sustained release, Hydralazine and Beta Blocker). All 3 were diagnosed to have unilateral renal artery stenosis. One child was lost to follow up, whereas the other 2 underwent renal angioplasty which was followed with normalization of blood pressure.
Despite activation of renin angiotensin axis secondary to renal artery stenosis, these groups of children have significant hyponatremia. Renal re-vascularisation produces excellent results in most of them.
Core tip: Renovascular hypertension can occur secondary to renal artery stenosis which can sometime present as hyponatremic hypertensive syndrome (HHS). Though deemed a rare disease we identified within a span of 18 mo, 3 children with HHS presentation characterized by hypertension, hyponatremia, hypokalemia and metabolic alkalosis. Despite activation of renin angiotensin axis secondary to renal artery stenosis, they had significant hyponatremia. Renal re-vascularisation produced excellent results in 2 children who underwent surgery whereas another child was lost to follow up.