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 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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