Secondary Hypertension in Young Age due to Renal Artery Stenosis
Erwin Dharmawan, Gde Raka Widiana, Ketut Suwitra, Wayan Sudhana, Jodi S Loekman, Yenny Kandarini, Paramita Ayu
Div. Nephrology and Hypertension Dept of Internal Medicine Faculty of Medicine Udayana University Bali Indonesia
Background : Secondary hypertension affect a small but significant number of the hypertensive population and, unlike primary hypertension, is a potentially curable condition. In young age, renal parenchimal disease and renovascular disease was the most common to cause secondary hypertension. Renovasular hypertension is defined as systemic hypertension due to oclussion or stenosis of renal artery.
Case presentation : A young female, 15 years old, Balinese came to emergency room presented with headache, shortness of breath, nausea and vomiting. On Physical examination found blood pressure 205/140 mmHg for right arm and 210/140 mmHg for left arm, pulse 120 x/min, equal pulsation for both arm, respiratory rate 22 x/min, temperature 36,8 oC, VAS 3/10 and IMT 16,79 kg/m2. There was no abdominal bruit. Laboratorium data showed AST 27 ɥ/L, ALT 28 ɥ/L, BUN 11, SC 0,61, Na 132 mmol/L, K 2,8 mmol/L. BGA with respiratory alkalosis and no proteinuria.Chest X-Ray and BOF within normal limit, ECG with sinus tachycardia, RAH and RVH. Echocardiography finding was hypertensive heart disease, mild PR, with normal systolic and dyastolic function. From abdominal MSCT-scan with contrast revealed right kidney with 8.2 x 3.05 x 3.3 cm in size, and stenosis right a. Renalis as long as ± 0.12 cm and suspect right renal hypoplasia. In the fifth day of admission, with combination of β-blocker and calcium antagonist as antihypertensive therapy, the pain was resolved and the blood pressure maintained within normal limit and planned for angiography and revascularization but the patient decided to postpone the procedure.
