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A Case of Secondar Hypertension

Published by : ayurdoctor on:14-11-13 03:16 PM

Case Report

  • 50 yrs old lady was referred for e/o uncontrolled hypertension of ~ 1yr.

  • She had exertional dyspnoea & palpitations 1 yr ago & was detected to be having HTN .

  • Treated with Atenolol & Amlodipine- still BP was not control.

  • At referral she was asymptomatic & leading normal life.

  • No h/o edema, haematuria, PIH.

  • Mother,maternal uncle, sister & 2brothers had HTN.





O/E

  • Moderately built, apparently healthy middle aged lady. PR-86/min, regular,all PP+ with N.volume.

  • BP-170/100mmHg (both UL) -186 mmHg SBP (both LL).

  • No PICCLE & JVP.

  • Cardiac apex could not be localized.

  • S1 n, A2 loud, S4+, 3/6 ESM @ LSB+

  • Chest was clear with NVBS.

  • No FND & optic fundui- normal.




Abdomen

  • Normal shape & non tender.

  • Irregular,lobulated, non-tender, firm mass of ~12 cms was bimanually palpable in right lumbar area & was ballotable.

  • Liver & Spleen were non palpable.

  • Band of resonance was + over the mass.

  • No shifting dullness

  • Normal bowel sounds + . No Bruits.

  • 50 yr old lady

  • F H/o HTN

  • ? Secondary / primary HTN

  • Uncontrolled HTN (stage III, No TOD)

  • Palpable enlarged Rt kidney.



    • ADPKD, Hydronephrosis, solitary cyst, hypernephroma, renal tumors, Pheo.., Adrenal mass...



  • Suspect secondary HTN if



    • Onset is < 20 yrs or > 50yrs.

    • Difficult to control(refractory) HTN.

    • Previously controlled HTN getting uncontrolled.

    • TOD @ detection of HTN



  • Causes of secondary HTN



    • Renal



      • AGN, Renal failure, ADPKD, RAS.



    • Endocrine



      • Cushing's, Pheo, thyrotoxicosis, Conn`s syndrome, Acromegaly...



    • Drugs



      • NSAID, Steroids, OCP...



    • COA

    • PIH

    • Alcohol

    • Inv: Hb-11 g%, ESR 40 @ 1Hr.

    • Urine Alb +, 4-5 RBC/HPF, no casts.

    • B urea26 mg%, creat 1.2 mg%, RBS 97 mg%, s Na136meql, S K 3.8 meqL

    • ECG - LVH & CXR wnl.

    • Usg: B/L nephromegaly (16 & 14 cm.) with numerous thin walled anechoic cysts of 5-30mm size. No calculi, hydro nephrosis.






3 cysts were seen in the rt lobe of liver.

  • sug of ADPKD.

  • ADPKD, Secondary HTN, with LVH.

  • HTN controlled with Enalapril, Amlodipine & Methyl dopa.




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