Abstract: PO0309
Hypertension Secondary to Obstructive Retroperitoneal Fibrosis
Session Information
- AKI: Clinical Case Reports
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 103 AKI: Mechanisms
Authors
- Dindu, Bindu Shravya, Creighton University School of Medicine, Omaha, Nebraska, United States
- Ahmed, Moeed, Creighton University School of Medicine, Omaha, Nebraska, United States
- Mutnuri, Sangeeta, Creighton University School of Medicine, Omaha, Nebraska, United States
- Nazmul, Mohammed, Creighton University School of Medicine, Omaha, Nebraska, United States
Introduction
Retroperitoneal fibrosis (RPF) has been known to cause ureteral compression leading to obstructive nephropathy. This case details RPF presenting as hypertensive emergency with acute on top of chronic kidney disease.
Case Description
A 62-year-old female with stage 3 chronic kidney disease and essential hypertension (HTN) presented to the emergency room with headache and elevated blood pressure (BP) of 200/121 mm Hg. Physical exam was significant for trace lower edema. Labs showed elevated creatinine at 13.8 (1.08 two months prior) and hyperkalemia, potassium at 5.8. Urine analysis was unremarkable. MRI revealed bilateral hydronephrosis and a soft tissue mass encasing the aortal bifurcation, abutting the ureters concerning for RPF vs. lymphoma. Subsequent MAG 3 showed significantly compromised left renal function. A foley was placed, returning 4.7 liters of urine in 24 hours. Her BP and headache improved with clonidine and nicardipine over the next 48 hours. Upon normalization of her BP and creatinine, patient was discharged. On follow up, CT guided biopsy of her mass confirmed RPF. Extensive workup for etiology was unrevealing, making a diagnosis of idiopathic RPF. Post discharge, a left ureteral stent was placed and repeat imaging after 3 months showed spontaneous regression of the mass with resolving hydronephrosis. The stent was removed, and the patient opted to pursue mycophenolate mofetil therapy to manage her RPF.
Discussion
Rarely detailed in medical literature, RPF induced secondary HTN has been proposed to be mediated by the tubuloglomerular feedback and renin angiotensin and aldosterone axis. Imaging can play a key role in diagnosing RPF. Whilst relieving obstruction can quickly resolve HTN in these patients, glucocorticoids and other immunosuppressive therapies can manage long-term progression.
Soft tissue mass encasing the distal abdominal aorta and aortic bifurcation, measuring 2.3 cm by 5.2 cm by 9.2 cm