Abstract: SA-PO379
When Hyponatremia Meets Hypertension: The Impact of Renal Artery Stenosis
Session Information
- Hypertension, CVD, and the Kidneys: Clinical Research
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Jumani, Muhammed Y., Marshall University, Huntington, West Virginia, United States
- Jumani, Yusra S., Dow University of Health Sciences, Karachi, Pakistan
- Kheetan, Murad, Marshall University, Huntington, West Virginia, United States
Introduction
Hyponatremic hypertensive syndrome (HHS) is characterized by severe hypertension and hyponatremia caused by unilateral renal artery stenosis (RAS). The ischemic kidney activates the renin-angiotensin system, causing hypertension. This leads to pressure diuresis in the non-ischemic kidney, with aldosterone and ADH secretion causing hyponatremia, hypokalemia, and polydipsia. Seemingly rare and under-diagnosed, this case report highlights HHS with underlying RAS in an elderly male with multiple comorbidities.
Case Description
92-year-old male with HFpEF, aortic stenosis, CAD, and hypertension presented with confusion, lethargy, hyponatremia (Na 125), and hypertension (BP 200/100). Normal TSH and cortisol levels ruled out hypothyroidism or adrenal insufficiency. Ultrasound showed high-grade left kidney stenosis. CTA confirmed 85-90% stenosis in the left renal artery. Fluid restriction initially exacerbated hypertension. Left renal artery stenting was performed, improving sodium levels and blood pressure, with significant improvement in renal artery blood flow. Lisinopril and salt tabs were added upon discharge.
Discussion
Hyponatremic hypertensive syndrome (HHS), particularly in the presence of RAS, requires comprehensive clinical evaluation and diagnostic imaging. Unilateral renal artery stenosis leads to high renin release from the ischemic kidney, causing hypertension and pressure diuresis in the non-ischemic kidney. This results in polyuria, polydipsia, and urinary sodium loss, leading to hyponatremia. Early diagnosis is crucial to prevent complications and preserve renal function. Renal artery stenting improves perfusion and sodium levels, while ACE inhibitors reduce intraglomerular pressure and renal injury progression.
In summary, managing HHS in the context of RAS requires understanding the pathophysiology, careful diagnostic workup, and a combination of interventional and pharmacologic treatments to improve outcomes.
Pre stent vs post stent in left renal artery