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Hypertensive Encephalopathy Treated by Percutaneous Nephrostomy *A1 Zamer J.,*Hamad B.,*A1 Yamani Y., *A1 Kaaabi A.**Ismail A

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Hypertensive Encephalopathy Treated by Percutaneous Nephrostomy *A1 Zamer J.,*Hamad B.,*A1 Yamani Y., *A1 Kaaabi A.**Ismail A QATAR MEDICAL JOURNAL | VOL. 16 / NO. 2 / NOVEMBER 2007 CASE REPORT Hypertensive Encephalopathy Treated by Percutaneous Nephrostomy *A1 Zamer J.,*Hamad B.,*A1 Yamani Y., *A1 Kaaabi A.**Ismail A. * Pediatrics and** Pediatric Surgery Department, Hamad Medical Corporation Doha, Qatar Abstract: Dismembered pyeloplasty was then done with the removal Although hypertension is a known complication of of nephrosotmy tube. The patient did well with the relief of his hydronephrosis, it is never severe enough to cause ence- left kidney obstruction. His blood pressure remained low 96/ phalopathy. 42 on average 1 year post pyeloplasty. Here we report a baby boy with unilateral hydrone- Discussion: phrosis who presented with hypertensive encephalopathy and whose condition was cured by the insertion of From the pathophysiological point of view, hypertension percutaneous nephrostomy followed by pyeloplasty. develops in two main ways: as a result of an excess of salt and fluid (volume mediated hyperteesion) or as a result of peripheral Case Report: arteriolar vasoconstriction (resistance mediated heypertension) which is usually accompanied by increased renin secretion. A 3 month old boy presented to our unit with irritability Another an important role in the pathogenesis of hypertension and generalized tonic clonic seizures. has also been ascribed to the lack of certain vasodepressor This patient is a known case of left hydronephrosis, diag- substances (prostaglandins) and to the autonomic nervous nosed antenatally on ultrasound. His renal pelvic anteroposterior system(1). diameter was found to be 22 mm with renal cortical thickness The relationship between hypertension and hydronephrosis of 5 mm postnately. is not easily explained in all cases. The clinical and laboratory His voiding cystourethrography, at age 10 days, showed no observations show different responses, depending on whether reflux. DTPA renal scan, done at the age of one month, showed the obstruction is unilateral, bilateral, acute or chronic. equal kidney functions but obstructive curve on the left side. Braasch and co workers found an elevated systolic blood On physical examination the child was drowsy. His blood pressure in 13.7% of a group of patients with unilateral pressure was found to be 159/90 mm Hg. He was admitted to hydronephrosis^. Schwartz (1969) found 30% incidence of the Pediatric Intensive Care Unit (PICU) where he was given hypertension in acute unilateral ureteral obstruction in Labetalol 4 mg/kg/hour intravenous infusion. As there was no comparison to 1.35% with chronic unilateral ureteral response ACE inhibitor, hydralazine and nifedipine were added. obstruction^. These, again, did not bring his blood pressure down. While in partial bilateral obstruction hypertension could be As there was no response to the above measures, it was explained simply by fluid volume expansion as a result of salt decided to perform percutanous left pelvic nephrostomy. This and water retension and azotemia, the situation is a bit different brought dramatic improvement of his blood pressure, which in unilateral obstruction. came down to 80-90/50-60 in a matter of 48 hours. All Acute unilateral obstruction can cause hypertension from medications for high blood pressure were stopped over a period activation of the renin -angiotenisn system. This is not of 10 days. necessary the case in chronic unilateral obstruction. Vaughan and associates (1974) found normal renin secretion in 13 hypertensive patients with chronic unilateral hydronephrosis^. Surgical correction of hydronephrosis is done to improve Address for correspondence: JamalAl Zamer, MD and preserve renal function. Pediatrics Department, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar It was proposed that surgical repair of the unilateral E-mail: jamalabdelhai@hotmail. com hydronephrosis solely to improve the associated hypertension 63 Hypertensive Encephalopathy Treated by Percutaneous Nephrostomy Al Zamer J., et. al. must be justified by establishing proof of increased renin Conclusion: secretion in the absence of a renal artery stenosis. Hypertensive encephalopathy as a complication of In our patient the peripheral renin level was normal. unilateral hydronephrosis is never reported before. Failing Percutaneous nephrostomy, invasive as it is, was used as a test medical measures to correct high blood pressure relieving to assess the efficacy of relieving the obstruction on the blood kidney obstruction should be thought of as a therapeutic line. pressure, before embarking on pyeloplasty. V DRTE* 03'04'2003 References: 90-02-28-23- 1. K Scharer: Renal hypertension in childhood. Annates Nestle, LEFT RIGHT 42,1:1-18,1984. 'x v 2. Brassch WF, W Walters and Hammer HJ. Hypertension and —J—"" the surgical kidney. JAMA, 115:1837, 1940. 3. Schwartz DT. Uniltarea upper urinary tract obstruction and arterial hypertension. N.Y.J. Med., 69: 668, 1969. HETHOB 2» FR l + i I WGHTD SUBTRACT 4. Vaughan ED, Jr Buhler FR and Laragh JH. Normal renin secretion in hypertensive patients with primary unilateral chronic hydronephrosis. J Urol., 112: 153, 1974. \ w 64 QATAR MEDICAL JOURNAL | VOL. 16 / NO. 2 / NOVEMBER 2007.
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