Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jan 6, 2017; 6(1): 41-44
Published online Jan 6, 2017. doi: 10.5527/wjn.v6.i1.41
Hyponatremic hypertensive syndrome - a retrospective cohort study
Devdeep Mukherjee, Rajiv Sinha, Md Shakil Akhtar, Agni Sekhar Saha
Devdeep Mukherjee, Rajiv Sinha, Md Shakil Akhtar, Department of Pediatric Medicine, Institute of Child Health, Kolkata 700017, India
Agni Sekhar Saha, Fortis Hospitals, Kolkata 700017, India
Author contributions: All the authors contribute to the paper.
Institutional review board statement: The study was reviewed and approved by the Institutional Ethics Committee.
Informed consent statement: Informed consent was taken from the parents of the patients enrolled for this study.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Data sharing statement: Participants gave informed consent for data sharing and the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rajiv Sinha, MD, FRCPCH (UK), CCT, Associate professor, Department of Pediatric Nephrology, Institute of Child Health, 11, Dr Biresh Guha Street, Kolkata 700017, India. rajivsinha_in@yahoo.com
Telephone: +91-93308-19380
Received: June 11, 2016
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
Abstract
AIM

To ascertain the frequency of hyponatremic hypertensive syndrome (HHS) in a cohort of children with hypertensive emergency in a tertiary pediatric hospital.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Hypertension; Hyponatremia; Renovascular; Encephalopathy; Paediatric

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.