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Compensatory renal hypertrophy in reflux nephropathy presenting as hypertensive emergency

Suria Emilia Suhana Othman Tan1, Siti Dayana Mohamad2, Muhamad Zabidi Ahmad1

  • 1Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Penang, Malaysia.

Oxford Medical Case Reports
|February 22, 2021
PubMed

Insights

Pediatric hypertensive emergency requires careful diagnosis. This case highlights how specific radiological exams, like DMSA scans, are crucial for accurate diagnosis and avoiding unnecessary tests in children with elevated blood pressure.

Area of Science:

  • Pediatric Nephrology
  • Diagnostic Radiology

Background:

  • Hypertensive emergencies in children can stem from various causes, necessitating a tailored diagnostic approach.
  • Prompt and accurate diagnosis is vital for effective management and preventing long-term complications.

Observation:

  • A child presented with symptoms of hypertensive emergency, including double vision and giddiness, with elevated blood pressure.
  • Initial blood work was unremarkable, prompting further investigation into potential renal pathology.

Findings:

  • Renal ultrasound and MRI revealed a suspected left kidney mass and a dysplastic right kidney.
  • Micturating cystourethrography and 99mTc-dimercaptosuccinic acid (DMSA) studies confirmed bilateral vesicoureteric reflux with left compensatory hypertrophy.

Implications:

  • This case underscores the importance of selecting appropriate radiological examinations for diagnosing pediatric hypertensive emergencies.
  • Strategic use of imaging can lead to accurate diagnoses while minimizing patient exposure to unnecessary procedures and associated costs.

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