Abstract 16932: Primary Hyperaldosteronism And Resistant Hypertension In Pregnancy

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Agnes Koczo ◽  
Malamo E Countouris ◽  
Alisse Hauspurg ◽  
Kathryn Berlacher
Keyword(s):  
Kidney Disease ◽  
Resistant Hypertension ◽  
Chronic Kidney Disease Stage ◽  
Growth Restriction ◽  
Primary Hyperaldosteronism ◽  
Disease Stage ◽  
Uncontrolled Hypertension ◽  
Progression Of Kidney Disease ◽  
History Of ◽  
In Pregnancy

Case Presentation: A 42-year-old woman with history of primary hyperaldosteronism (PA), IDDM and chronic kidney disease stage 3b (baseline Cr 2.5 mg/dl) presented at 10 weeks gestation with uncontrolled hypertension during pregnancy. Given prior difficulties conceiving and lack of discussions surrounding pregnancy risks, preconception counseling had not been done. She was taking carvedilol, spironolactone, and furosemide at pregnancy diagnosis. Given unclear safety profile in pregnancy, her spironolactone was discontinued. Her regimen was uptitrated to nifedipine 90 mmHg, carvedilol 50mg BID, hydralazine 50mg TID and furosemide 80mg BID. At 18 weeks gestation, she was readmitted with severe range hypertension and fluid overload unresponsive to escalating diuretic dosing. Due to poor urine output and creatinine to 5.5 mg/dl, she was initiated on dialysis. Her fetus was diagnosed with severe intrauterine growth restriction (IUGR) and umbilical doppler noted reversal of umbilical artery end-diastolic flow indicating severely elevated arterial resistance (Figure). During admission, she developed resistant hypertension requiring nicardipine and esmolol drips and severe headache, concerning for superimposed preeclampsia (SIPE). At 25 weeks gestation, she was taken for urgent c-section. Given extreme prematurity and growth restriction, her newborn baby passed away shortly after delivery. Discussion: This case highlights complications which arise from PA and antepartum persistent hypertension including progression of kidney disease, heart failure, IUGR, SIPE, and preterm delivery. It further highlights unique challenges using targeted therapies of mineralocorticoid receptor antagonists in PA in pregnancy. This information is crucial as PA is an increasingly recognized cause of resistant hypertension in young adults. Both PA and preeclampsia involve pathophysiologic mechanisms in the RAAS pathway and deserve further attention and research.

scholarly journals Hypertension, Chronic Kidney Disease, and Renal Pathology in a Child with Hermansky-Pudlak Syndrome

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Roberto Gordillo ◽  
Marcela Del Rio ◽  
David B. Thomas ◽  
Joseph T. Flynn ◽  
Robert P. Woroniecki
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Stage Ii ◽  
Renal Pathology ◽  
Disease Stage ◽  
Not Otherwise Specified ◽  
Ckd Stage ◽  
History Of ◽  
Hermansky Pudlak Syndrome

We report a child with Hermansky-Pudlak Syndrome (HPS) and chronic kidney disease (stage II) with histological diagnosis of focal segmental glomerulosclerosis (FSGS). A 15-year-old male of Puerto Rico ancestry with history of HPS, hypertension (HTN), asthma, obesity, and chronic kidney disease (CKD) stage II presented with new-onset proteinuria without edema. His blood pressure had been controlled, serum creatinine had been 0.9–1.4 mg/dL, and first morning urine protein/creatinine ratio (UPC) ranged from 0.2 to 0.38. Due to persistent nonorthostatic proteinuria with CKD, renal biopsy was performed and FSGS (not otherwise specified) with chronic diffuse tubulopathy (tubular cytoplasmic droplets) and acute tubular injury was reported. Ceroid-like material is known to infiltrate tissues (i.e., lungs, colon, and kidney) in HPS, but the reason for the renal insufficiency is unknown. Nonspecific kidney disease and in one adult case IgA nephropathy with ANCA-positive glomerulonephritis have previously been reported in patients with Hermansky-Pudlak syndrome. To our knowledge, we report the first pediatric renal pathology case of HPS associated with CKD. This paper discusses presentation and management of renal disease in HPS.

PREGNANCY MANAGEMENT IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 4

2019 ◽  
Vol 23 (2) ◽  
pp. 109-116
Author(s):  
N. L. Kozlovskaya ◽  
Y. V. Korotchaeva ◽  
K. A. Demyanova ◽  
M. M. Engibaryan ◽  
M. S. Mikulyak ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Advanced Stage ◽  
Healthy Baby ◽  
Stage 4 ◽  
Calcium Phosphorus ◽  
History Of ◽  
Rare Situation

Pregnancy in patients with an advanced stage of chronic kidney disease (CKD) remains a rather rare situation to date. This observation demonstrates our own experience of successfully management of pregnancy in a patient with chronic kidney disease stage 4. A special feature of this observation is an unclear diagnosis that led to CKD. Based on a combination of advanced CKD in a young patient with no kidney history, no changes in urine tests, increased blood pressure, hyperuricemia, and small cysts of both kidneys, a diagnosis of autosomal dominant tubulo-interstitial kidney disease was suggested, despite the lack of family history of renal disease. Since the kidney disease was first identified during pregnancy, the main areas of care were the correction of complications (anemia, calcium-phosphorus disorders), caused by the advanced stage of CKD and the prevention of pre-eclampsia as one of the most frequent complications of pregnancy in this cohort of patients. In order to timely diagnose preeclampsia, the patient was regularly monitored for angiogenesis markers. Conducting pregnancy was carried out by an interdisciplinary team of specialists (nephrologists, obstetrician-gynecologists). Pregnancy ended with the birth of healthy baby. After childbirth renal failure progressed.

A 78-year-old female patient with severe resistant hypertension and chronic kidney disease stage 5 treated by renal denervation

2014 ◽  
Vol 19 (3) ◽  
pp. 187-188
Author(s):  
Sergio Morelli ◽  
Gaetano Tanzilli ◽  
Luigina Farina ◽  
Giorgia Rubini ◽  
Giancarlo Ralli ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Female Patient ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage

scholarly journals Chronic kidney disease in pregnancy: Maternal and fetal outcomes and progression of kidney disease

2015 ◽  
Vol 8 (2) ◽  
pp. 92-98 ◽  
Author(s):  
Natalie L Davidson ◽  
Penny Wolski ◽  
Leonie K Callaway ◽  
Helen L Barrett ◽  
Narelle Fagermo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Pregnancy Outcomes ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Control Group ◽  
Tertiary Institution ◽  
The Impact ◽  
In Pregnancy

Background There is a paucity of Australian data regarding renal disease in pregnancy. We undertook a retrospective cohort study at a tertiary institution to examine the impact of renal disease on pregnancy outcomes and the effect of pregnancy on disease progression. Methods A total of 55 pregnancies of patients with renal disease admitted from 2003 to 2010 to the Royal Brisbane and Women’s Hospital were analysed. Pre-conception variables, fetal/delivery and maternal outcomes were analysed in this group and in a control group of women with normal kidney function pre-pregnancy. Results Of the 55 pregnancies, 71% experienced pre-term delivery, 38% had intra-uterine growth restriction and 62% required caesarean section. Of all, 60% of neonates required neonatal intensive care unit (NICU) admission and six perinatal deaths occurred. Of all, 67% of women suffered preeclampsia, 47% anaemia and 3 patients required dialysis in pregnancy. Postpartum deterioration of renal function occurred in patients with pre-conception chronic kidney disease stage 3–5. Conclusions Chronic kidney disease of all stages is a risk factor for adverse pregnancy outcomes. In a tertiary institution however, there is a high rate of successful pregnancy (84%).

scholarly journals Acute Ischemic Stroke and Acute on Chronic Kidney Disease

2016 ◽  
Vol 54 (202) ◽  
pp. 85-87
Author(s):  
Raja Ahsan Aftab ◽  
Amer Hayat Khan ◽  
Hadeer Akram AbdulRazzaq ◽  
Azreen Syazril Adnan
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Acute Ischemic Stroke ◽  
Thrombus Formation ◽  
Chronic Kidney Disease Stage ◽  
Sudden Onset ◽  
Disease Stage ◽  
Uncontrolled Hypertension ◽  
Ischemic Disease

Ischemic stroke is due to either local thrombus formation or emboli that occlude a cerebral artery, together with chronic kidney disease represent major mortality and morbidity. Here wer present a case of 53 years old Malay man, admitted to a hospital in Malaysia complaining of sudden onset of weakness on right sided upper and lower limb associated with slurred speech. Patient was also suffering from uncontrolled hypertension, hyperlipidemia, chronic kidney disease stage 4, and diabetes mellitus(un controlled). He was diagnosed with acute ischemic stroke with cranial nerve 7 palsy (with right hemiparesis), acute on chronic kidney disease precipitated by dehydration and ACE inhibitor, and hyperkalemia. Patients with ischemic disease and chronic kidney disaese require constant monitering and carefull selected pharmacotherapy. Patient was placed under observation and was prescribed multiple pharamacotherpay to stabalise detoriating condition. Keywords: ischemic disease; chronic kidney disease; uncontrolled hypertension. | PubMed

scholarly journals The Relationship between Diabetes Mellitus History with Chronic Kidney Diseases in Inner Disease Room RSUD dr. M. Yunus Bengkulu

2020 ◽  
Vol 24 (3) ◽  
pp. 1-10
Author(s):  
Devi Listiana ◽  
Awal Isgiyanto ◽  
Icha Alvionita
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Health Workers ◽  
Kidney Diseases ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Bivariate Analysis ◽  
Cross Sectional ◽  
History Of

This study aimed to study the association of history of diabetes mellitus with chronic kidney disease in Inner Disease Room RSUD dr. M. Yunus Bengkulu. This research used cross sectional design. The population in this study patients with kidney failure who were treated in the Inner Disease Room RSUD dr. M. Yunus Bengkulu, amounting to 142 patients. Sampling technique total sampling that was all patient of chronic kidney disease which was treated in Inner Disease Room RSUD dr. M. Yunus Bengkulu  which amounted to 142 patients sampled. The data collection in this study used secondary data by looking at documentary records in the Inner Disease Room of dr. M. Yunus Bengkulu. Data analysis technique was done by using univariate and bivariate analysis with Chi-Square  (χ2 ) statistic test through SPSS program.The results of the study were: from 142 patients, there were 74 patients (52.1%) with chronic kidney disease stage 5, 80 patients (56.3%) had a history of diabetes mellitus, there was a significant relationship between history of diabetes mellitus with chronic kidney disease in Inner Disease Room RSUD dr. M. Yunus Bengkulu with moderate relationship category, and patients with a history of diabetes mellitus have a risk 6 times compared of chronic kidney disease stage 5 with patients who have no history of diabetes mellitus. It was expected that health workers, especially nurses in order to provide more complete nursing care, especially in patients with chronic kidney disease.

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