Hypertensive crisis in patient with acute renal failure
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Secondary hypertension accounts for 5–10% of all the cases of hypertension although its true prevalence has still not been fully defined. The kidney is most frequent cause of secondary hypertension, depending on the series, it being involved in about 5–15% of the cases. These causes are, in turn, divided into parenchymal, vascular and less often secondary to obstructive renal disease. There are few cases in the literature regarding hypertensive crisis in connection with acute urinary obstruction and acute renal failure (ARF).
Although very few references have been published, from a physiological point of view, we are probably dealing with a case of hypertension sensitive to volume changes, in which a relative increase in volume caused by urinary obstruction may contribute to an increase in blood pressure (BP) values in hypertensive patients. Some cases have also been described in which, after a unilateral or bilateral obstruction of both ureters and urethra, hypertension may occur due to activation and inhibition of renin kallikrein.
We present the case of a 64-year old man with a background of 4–5 years of hypertension with controlled BP who came to the Emergency Department due to a 24-h long anuria with hypertensive crisis and ARF. The radiographic images showed no presence, dilatation of the urinary tract, however the clinical findings were suggestive of obstructive ARF. Thus, we decided to perform a urinary diversion, and extracted a calculus after which the patient began with diuresis having a polyuric rhythm, control of the BP values and recovery from the ARF.