A 44-year-old patient, with no history of interest except for 10 years of evolution, was treated with enalapril 30mg, hypertension was not diagnosed 10mg and hydrochlorothiazide was not monitored periodically.
She consulted for presenting, for 4-5 months, high BP values (160-180/95-100mmHg) with frequent hypertensive crisis that led to admission to the emergency department.
Nonsteroidal anti-inflammatory drugs and a history of lithiasis or urinary infection were not prescribed, although chronic left inguinal pain attributed to dysmenorrhea and for which no study was performed.
Physical examination revealed: body mass index 29kg/m2, BP 167/94mmHg, 87bpm, normal cardiopulmonary auscultation, glottal abdomen and minimal bilateral malleolar edema.
The following complementary examinations were performed, the results of which were:
- Ambulatory blood pressure monitoring (ABPM): daytime average 151mmHg, 61lpm, pulse pressure 70.6mmHg, night average 137/70mmHg, 57lpm, pulse pressure 66.8mmHg.
Maximum diurnal BP 183/99mmHg, nocturnal 171/95mmHg.
Non-perfect pattern.
- Electrocardiogram: sinus rhythm 72lpm; Sokolow <35mm; asymmetric T wave inversion.
- Echocardiogram: septal defect 12mm.
- Normal chest X-ray.
- Normal eye fund.
- Ecoabdomen: right kidney (RD) 13cm normal differentiation; left kidney (LK) 25cm hydronephrotic, without corticomedullary differentiation.
- Analytical: complete blood count, normal lipid profile, normal glycaemia.
Urea 31mg/dl, 0.79mg/dl, glomerular creatinine (MDRD-4) >60ml/min/1.73m2.
- seizure renina plasma (ARP) 1.35ng/ml/h (normal radioimmune range: 0.2-3.3ng/h).
- Urine: 0,11g/24h proteinuria, creatinine 161mg/d, Na 241Eq/l, excretion of Na 0,78%.
Feeling sick: 5 ills/field, 30 leucocytes/field, negative nitrites; creatinine clearance 113ml/min.
- Angio-CT (computed axial tomography): lithiasis and ipsilateral nephrohidrosis causing traction of the renal artery.
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- Gammagraphy-dimercaptosuccinic-technetium99: DR 100%, IR 0%.
The patient was diagnosed with moderate grade 2 hypertension of renovascular origin and functional IR cancellation. A left laparoscopic nephrectomy was performed with no complications.
The pathological anatomy of the specimen reported hydronephrotic kidney of lithiasic etiology, chronic pyelonephritis in the acute phase, acute erosive pyelonephritis and urticarial cysts.
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The renal evolution was favorable.
Renal clearance and creatinine deteriorated slightly and transiently after nephrectomy, returning to baseline levels in less than 15 days.
BP decreased significantly.
The post-intervention renogram revealed a DR with good vascularization and radiotracer uptake capacity, as well as adequate response to the diuretic.
The sequential images and the renographic curve showed adequate elimination, without ectasia and without obstructive behavior.
At present, after three years of the intervention, BP remains well controlled (self-measured and MAPA) with a lecharacterized proteinuria of 20mg/day (10mg/day) and creatinine clearance of 1.1mg/ml (0.
He hasn't had groin pain again.
