Rare and Treatable Case of Hypertension in Adolescent

Abstract

Renal segmental hypoplasia or Ask-Upmark kidney is a rare congenital kidney disorder that can be associated with hypertension. A 12-year-old girl previously healthy was referred to our emergency department with anxiety crisis and high blood pressure. The physical examination was unremarkable except for a blood pressure extremely high (191/141 mmHg). Echocardiography revealed left ventricular hypertrophy. Renal ultrasound showed a renal asymmetry with a small left kidney. She was treated with three antihypertensive agents without blood pressure normalization. Further investigation included doppler ultrasound and computed tomography angiography which revealed atrophic left kidney and a narrow but permeable renal left artery. No radionuclide uptake was observed in captopril renogram. Patient underwent a left nephrectomy with marked improvement in blood pressure control. Macroscopic appearance of the atrophic kidney showed segmental hypoplastic area with absence of glomeruli, atrophic tubules and thick walled arteries at histological findings with associated hypoplasia of the renal artery. Hypertension can be silent and screening children and adolescents for elevated blood pressure could identify hypertension at an early stage and identify secondary causes. This condition is rare and the diagnosis is crucial because it is a potentially curable cause of hypertension in the young people.