Tragedy of transition: hypertensive crisis in a young adult secondary to unilateral ureteropelvic junction obstruction following pyeloplasty as an adolescent

Abstract

A 25-year-old man with a history of left ureteropelvic junction (UPJ) obstruction that was corrected surgically at the age of 16 presented with a chief complaint of syncope. He was found to have severe hypertension with evidence of end organ damage on laboratory evaluation. His blood pressure was controlled with intravenous and oral antihypertensives with improvement in end organ dysfunction. Workup for secondary causes of hypertension implicated failed left-sided pyeloplasty with resultant hydronephrosis as the aetiology. The patient was transitioned to an oral antihypertensive regimen and discharged with urological surgery follow-up. Blood pressure control was maintained with oral antihypertensives and a low-salt diet; however, evidence of chronic kidney disease persisted. This case highlights the importance of close follow-up and adequate transition of care in patients with UPJ obstruction who transitioned to adulthood.

Acute bilateral ureteropelvic junction obstruction as a rare cause of hypertensive crisis: a case report

“…UPJ obstruction is an anatomical distortion causing the impediment of urinary flow from the renal pelvis to the ureter, increasing back pressure to the kidneys and eventually leading to hydronephrosis. It is most often congenital and is diagnosed during childhood as part of the workup for secondary hypertension [ 3 ]. In contrast, acquired UPJ obstruction causing hydronephrosis is more common in adults secondary to nephrolithiasis, previous surgery, or malignancy.…”

“…Ureteropelvic junction (UPJ) obstruction, as a cause of secondary hypertension, commonly occurs in children secondary to a congenital malformation [ 2 , 3 ]. It can usually be diagnosed in utero through routine prenatal ultrasound or may present as recurrent urinary tract infections during childhood [ 3 ]. On the other hand, secondary hypertension due to an acquired bilateral obstructive uropathy among adults is less frequently encountered [ 4 ].…”