The hyponatraemic hypertensive syndrome in a 2-year-old child with behavioural symptoms

Abstract

Behavioural abnormalities in the history of a child without any other neurological symptoms might be one of the first signs of hypertensive encephalopathy. In combination with hyponatraemia, these symptoms should alert the physician to consider the hyponatraemic hypertensive syndrome.

Two cases of hyponatremic-hypertensive syndrome in childhood with renovascular hypertension

“…We hypothesized that the symptoms of HHS would develop in children only when the stenosis in the affected artery became so severe that revascularization by PTRA was impossible. In the literature, only seven case reports of pediatric HHS with renovascular hypertension were found [2,5,6,9,10,16]. Of the nine reported cases, including the present two, PTRA was technically successful in only one case [10].…”

Hyponatremic hypertensive syndrome in pediatric patients: is it really so rare?

“…Although initially considered a rare condition, HHS has been identified in approximately 16% of adults with unilateral renal artery stenosis [4,10]. Data on the pediatric population are still sparse [5][6][7][8][9][10][11]. In an editorial commentary, Nicholls [2] suggested that HHS may be underdiagnosed in children and probably more common than previously thought.…”

“…All presented with severe hypertension, thirst, polyuria, weight loss, confusion, and hyponatremia. HHS has been described in children as well [5][6][7][8][9][10][11][12][13], starting with the report of Blanc et al [5] in 1991. Laboratory findings of elevated plasma levels of renin in most cases suggest that the stimulation of renin release from the ischemic kidney plays an important pathophysiologic role.…”

Unilateral renal ischemia causing the hyponatremic hypertensive syndrome in children—more common than we think?

“…It seems, however, that the HH syndrome secondary to unilateral renal ischemia in children has been documented as case reports involving only one or two patients [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Indeed, most reported discussions of renovascular disease in the pediatric age group make little or no mention of the HH syndrome [38].…”

“…Vomiting is common and could contribute considerably to the electrolyte disturbances whilst exacerbating volume depletion. In children and neonates, presenting features are polydipsia, polyuria or enuresis, weight loss and volume depletion, drowsiness, and, as in adults, various neurological and behavioral signs and symptoms [7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”