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.
Division of Pediatric Nephrology, Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, MO 63104.
T E
TE
Bunchman
A R
AR
Sinaiko
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