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Sudden-onset hypertension leading to the diagnosis of unilateral hydronephrosis due to ureteropelvic junction obstruction

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Abstract

We present a case of a 41-year-old female who developed hypertension over a three-month period and was subsequently diagnosed with ureteropelvic junction obstruction (UPJO). The patient came to our department with elevated blood pressure. Blood examinations revealed normal renal function, hypokalemia and increased renin-angiotensin system (RAS) activity, as indicated by elevated level of plasma renin activity and plasma aldosterone level. A computed tomography imaging further revealed dilation of the left renal pelvis, atrophy of the left kidney, and indications of obstruction at the junction between the renal pelvis and ureter. Surgical intervention in the form of a left pyeloplasty successfully resolved the unilateral hydronephrosis, corrected the elevated RAS activity, normalized the blood pressure, and ameliorated the hypokalemia. This case emphasizes that elevated blood pressure might be the sole clinical indication of hydronephrosis. It's crucial to consider hydronephrosis due to UPJO as a potential cause, especially when diagnosing hypertension associated with RAS hyperactivity in young adults. It also highlights the effectiveness of surgical intervention in treating hypertension in such scenarios.

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Authors and Affiliations

  1. Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-Chou, Itabashi-Ku, Tokyo, 173-8610, Japan

    Yoshihiro Nakamura, Hiroki Kobayashi & Masanori Abe

  2. Department of Urology, National Hospital Organization Saitama Hospital, Saitama, Japan

    Kunimitsu Kanai

Authors
  1. Yoshihiro Nakamura
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  2. Hiroki Kobayashi
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  3. Kunimitsu Kanai
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  4. Masanori Abe
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Correspondence to Hiroki Kobayashi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from the patient described in this case report.

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Nakamura, Y., Kobayashi, H., Kanai, K. et al. Sudden-onset hypertension leading to the diagnosis of unilateral hydronephrosis due to ureteropelvic junction obstruction. CEN Case Rep (2023). https://doi.org/10.1007/s13730-023-00832-4

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