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Kidney Week

Abstract: PO2315

Hypertensive Crisis in an Infant: The Mass Effect

Session Information

Category: Trainee Case Report

  • 1700 Pediatric Nephrology

Authors

  • Chawla, Jonathan Sterling, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
  • Manning, David, Children's Hospital New Orleans, New Orleans, Louisiana, United States
  • Ashoor, Isa, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
Introduction

It is unusual for congenital hydronephrosis to present with a hypertensive crisis. Recognition of this etiology and prompt urologic intervention to relieve the acute mass effect is critical to prevent further morbidity and mortality.

Case Description

A 3 month-old male with known, mild, right-sided hydronephrosis secondary to ureteropelvic junction obstruction (UPJO) presented to the ED with one week of poor feeding, emesis, and abdominal distension. His recent urine output had been normal. Right upper extremity blood pressure (BP) was recorded as 140/79 mmHg in the ED. Labs were unremarkable with a normal urinalysis and serum creatinine of 0.3 mg/dL. Abdominal ultrasound revealed massive pelvocaliectasis of the right kidney with the kidney parenchyma stretched and thinned over the massively dilated central collecting system. Findings were confirmed on abdominal CT which also revealed profound mass effect on abdominal organs and vessels, specifically compressing and displacing the aorta and inferior vena cava. He was admitted to the pediatric ICU for BP management, which was controlled with IV hydralazine. Pediatric urology placed a percutaneous nephrostomy tube and drained over one liter of urine from the right collecting system. At discharge, the patient was normotensive off medications. A right pyeloplasty was completed shortly following discharge.

Discussion

UPJO is the most common cause of antenatally detected hydronephrosis. The renal pelvis of infants exhibits increased compliance and can accommodate large urine volumes. Kidney function may be preserved or could undergo deterioration depending on UPJO severity. If missed prenatally, infants with UPJO may present with a palpable abdominal mass, urinary tract infection, hematuria, or failure to thrive. Kidney failure and hypertensive crises are rare presentations but are indications for prompt surgical intervention to prevent permanent damage and reduce blood pressure. Infants with preserved function can be monitored conservatively with serial imaging.