Renovascular hypertension presenting with hypokalemic metabolic alkalosis.
This report describes two adolescents with severe hypertension secondary to renal artery stenosis who had evidence of a hypokalemic metabolic alkalosis in their initial laboratory evaluation. Hypokalemic metabolic alkalosis is known to occur in approximately 16% of adults with renal artery stenosis but has not been well described in the pediatric literature. It is the result of excess aldosterone secretion stimulated by renal artery stenosis-mediated activation of the renin-angiotension system and by an increase in natriuresis from the contralateral, non-stenotic kidney. Although primary hyperaldosteronism must be considered in children with hypertension and hypokalemia, it is a rare disease in children. This report supports current recommendations that the initial focus of medical investigation in the severely hypertensive child should remain on the kidney.
Bunchman
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Division of Pediatric Nephrology, Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, MO 63104.
Sinaiko
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D000293:Adolescent; D000471:Alkalosis / Q000150:complications*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications; D006978:Hypertension, Renovascular / Q000150:complications* / Q000209:etiology; D007008:Hypokalemia / Q000150:complications*; D012078:Renal Artery Obstruction / Q000150:complications