Trinity College, 6 Hoskin Ave., Toronto, Ont. M5S 1H8;. (416) 978-8454. Oct. 16-20, 1990: Canadian Cardiovascular Society. 43rd Annual Meeting. World Trade ...
Hypokalemic hypertension associated with unilateral hydronephrosis David J. Hirsch, MD, FRCPC; Kailash K. Jindal MD, FRCPC ypertension in association with unilateral of the left kidney. Renal angiography revealed no hydronephrosis is a rare, surgically remedia- evidence of renal artery stenosis. The right kidney ble form of hypertension.",2 Hyperreninemia appeared normal. Selective venous studies showed has been reported in some cases,'3 but electrolyte the following renin activity (pg-L-'-s-' of generated disorders due to secondary hyperaldosteronism have angiotensin II): right renal vein 1253, left superior not. We describe a patient with hypertension and renal vein 3366, left inferior renal vein 1199, inferihypokalemic alkalosis attributable to unilateral hy- or vena cava 1171. Retrograde pyelography of the dronephrosis. left kidney revealed a smooth, tight stenosis of unknown cause at the ureterovesical junction, of Case report unknown cause. Cystoscopy did not reveal any lesion at the ureteric orifice on the obstructed side. A 64-year-old woman was referred with a Left nephrectomy was performed. Pathological 20-year history of hypokalemia and hypertension; examination revealed hydronephrosis and cortical her maximal blood pressure was 180/110 mm Hg. atrophy without evidence of arterial stenosis or There was no history of vomiting or diarrhea. She tumour. Two months after surgery the patient's had been receiving combined therapy with thiazide, blood pressure was 160/90 mm Hg without medica25 mg/d, and triamterene, 50 mg/d, for the past 15 tion, and the electrolyte levels were normal. years; despite oral therapy with potassium supplements the serum potassium level had occasionally Comments been as low as 2.5 mmol/L. A change in regimen to diltiazem, 240 mg/d, In the case we have described, the secondary controlled the hypertension but did not eliminate the hyperaldosteronism was considered to have caused hypokalemia; potassium, 20 mmol/d, and amiloride, the electrolyte disorder since the renin and aldoster5 mg/d, were required to maintain the serum potassi- one levels were elevated and could not be lowered um level above 4 mmol/L. Evaluation of the urinary with saline loading, and the urinary excretion of excretion of potassium when she was not receiving potassium was increased. The defect was corrected medication demonstrated an inappropriately high with the removal of the hydronephrotic kidney. transtubular potassium gradient, 19:1, at a serum The exact duration of the hydronephrosis is potassium level of 3.9 mmol/L.4 Metabolic alkalosis unknown, but the long history of hypokalemia sugpersisted, the serum bicarbonate level being 33 gests that it was present for many years. The hymmol/L. The serum magnesium concentration was dronephrosis probably accounted for the hypertennormal. sion as well since the blood pressure returned to After intravenous saline loading the plasma normal after nephrectomy. Alternatively, essential aldosterone concentration and renin activity with hypertension may have been present before the the patient supine were 2105 (normally less than hydronephrosis; however, this is unlikely, because 416) pmol/L and 1809 (normally less than 417) essential hypertension is not commonly associated pg-L-'-s-' of generated angiotensin II respectively. with hypokalemia, which was present for many The amount of angiotensin II generated was deter- years. mined by radioimmunoassay. The serum creatinine We recommend that unilateral hydronephrosis level was normal (92 ,mol/L). be considered in the differential diagnosis of hyperRenal ultrasonography 2 years earlier had dem- tension associated with refractory hypokalemia. This onstrated hydronephrosis and severe cortical atrophy rare condition may be corrected through surgery. H
Dr. Hirsch is associate professor and Dr. Jindal assistant professor, Department of Medicine, Dalhousie University,
Halifax.
Reprint requests to: Dr. David J. Hirsch, Rm. 5079, Ambulatory Care Centre, Victoria General Hospital, Halifax, NS B3H 2Y9 -
For prescribing information see page 1324
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References 1. Weidmann P, Beretta-Piccoli C, Hirsch D et al: Curable hypertension with unilateral hydronephrosis. Ann Intern Med 1977; 87: 437-440 2. Vaughan ED, Buhler FR, Laragh JH: Normal renin secretion in hypertensive patients with primarily unilateral chronic
Conferences continuedfrom page 1259 Oct. 12-14, 1990: Freud and the History of Psychoanalysis Trinity College, University of Toronto Dr. Andrew Brink or Herma Joel, 300 Larkin Building, Trinity College, 6 Hoskin Ave., Toronto, Ont. M5S 1H8; (416) 978-8454 Oct. 16-20, 1990: Canadian Cardiovascular Society 43rd Annual Meeting World Trade and Conference Centre, Halifax Secretariat, 401-360 Victoria Ave., Westmount, PQ H3Z 2N4; (514) 482-3407 Oct. 17-20, 1990: Canadian Group Psychotherapy Association 11th Annual Conference Minto Place Suite Hotel, Ottawa Dr. Allen A. Surkis, 675-1650 Cedar Avenue, Montreal, PQ H3G 1A4; (514) 934-8010 Le 18-20 oct. 1990: 1 le congres annuel de la Societe quebecoise de biochimie clinique H6tel Chateau Mont Sainte-Anne, Beaupre, PQ Pierre Douville, president du Comite organisateur, Service de biochimie, H6tel-Dieu de Quebec, 11 C6te du Palais, Quebec, PQ GI R 2J6; (418) 691-5135
Oct. 22-24, 1990: Institute for the Prevention of Child Abuse 5th National Conference - Focus on Child Abuse: Stop the Hurt Delta Chelsea Inn, Toronto
Note: originally scheduled for Sept. 24-26, 1990 Consultation and Conferences Services, Institute for the Prevention of Child Abuse, 25 Spadina Rd., Toronto, Ont. M5R 2S9; (416) 921-3151, FAX (416) 921-4997 Oct. 26-28, 1990: Canadian Sex Research Forum 17th Annual Meeting Whistler Conference Centre, Whistler, BC Shirley A. Halliday, executive director, Canadian Sex Research Forum, Sexual Medicine Unit, University Hospital- Shaughnessy Site, 4500 Oak St., Vancouver, BC V6N 3N1; (604) 875-2027 Oct. 31-Nov. 3, 1990: Ameripn Medical Writers Association 50th Annual C-onference Biltmore Hotel, Los Angeles American Medical Writers Association, 9650 Rockville Pike, Bethesda, MD 20814; (301) 493-0003 1262
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hydronephrosis. J Urol 1974; 1 12: 153-156 3. Riehle RA, Vaughan ED: Renin participation in hypertension associated with unilateral hydronephrosis. J Urol 1981; 126: 243-246 4. West ML, Marsden PA, Richardson RMA et al: New clinical approach to evaluate disorders of potassium secretion. lVin ElectrolVte Metab 1986; 12: 226-233
Nov. 1-4, 1990: Quebec Association of Urologists 15th Annual Meeting Four Seasons Hotel, Montreal Ms. Jacqueline Deschenes, Quebec Association of Urologists, 2 Complexe Desjardins (East Tower), Door 3000, PO Box 216, Stn. Desjardins, Montreal, PQ H5B 1G8; (514) 844-9523 Nov. 11-13, 1990: Canadian Hospital Association National Conference on Waste Management for Health Care Facilities Radisson Hotel, Ottawa Conferences, Canadian Hospital Association, 100- 17 York St., Ottawa, Ont. KIN 9J6; (613) 238-8005, FAX (613) 238-6924 Nov. 23-24, 1990: Canadian Bioethics Society 2nd Annual Meeting - Autonomy, Donation and Sharing as Issues in Bioethics
Chateau Frontenac, Quebec City Dr. Harry Grantham, H6tel-Dieu de Quebec, 1 1, cote du Palais, Quebec, PQ GIR 2J6; (418) 691-5075, FAX (418)691-5331
Apr. 21-24, 1991: Canadian Organization for the Advancement of Computers in Health 16th Annual Conference Sheraton Centre, Toronto Steven A. Huesing, executive director, Canadian Organization for the Advancement of Computers in Health, 1200- 10460 Mayfield Rd., Edmonton, Alta. T5P 4P4; (403) 489-4553, FAX (403) 489-3290
May 13-16, 1991: 7th World Congress on Emergency and Disaster Medicine Palais de Congres, Montreal Ms. Ursula Schwarz, Meeting Secretariat, Kush Medical Communications, 210-16 Four Seasons Place, Etobicoke, Ont. M9B 6E5; (416) 621-5663, FAX (416) 621-5352 May 26-29, 1991: 5th Canadian Congress of Rehabilitation Prince Edward Hotel, Charlottetown Dr. A.S. Muzumdar, director and head, Department of Physical Medicine and Rehabilitation, Queen Elizabeth Hospital, PO Box 6600, Charlottetown, PEI CIA 8T5; (902) 566-6060 For prescribing information see page 1327
