Case Report

l      50 yrs old lady was referred for e/o  uncontrolled hypertension of ~ 1yr.

l      She had exertional dyspnoea & palpitations 1 yr ago & was detected to be having HTN .

l      Treated with Atenolol & Amlodipine- still BP was not ¯ control.

l      At referral she was asymptomatic & leading normal life.

l      No h/o edema, haematuria, PIH.

l      Mother,maternal uncle, sister & 2brothers had HTN.

O/E

l      Moderately built, apparently healthy middle aged lady.

PR-86/min, regular,all PP+ with N.volume.

l      BP-170/100mmHg   (both UL)                                       -186 mmHg SBP (both LL).

l      No PICCLE & JVP.

l      Cardiac apex could not be localized.

l      S1 n, A2 loud, S4+, 3/6 ESM @ LSB+

l      Chest was clear with NVBS.

l      No FND & optic fundui- normal.

Abdomen

l      Normal shape & non tender.

l      Irregular,lobulated, non-tender, firm mass of ~12 cms was bimanually palpable in right lumbar area & was  ballotable.

l      Liver & Spleen were non palpable.

l      Band of resonance was + over the mass.

l      No shifting dullness.

l      Normal bowel sounds + . No Bruits.

l      50 yr old lady

l      F H/o  HTN

l      ? Secondary / primary HTN.

l      Uncontrolled HTN (stage III, No TOD)

l      Palpable enlarged Rt kidney.

–        ADPKD, Hydronephrosis, solitary cyst, hypernephroma, renal tumors, Pheo.., Adrenal mass…

l      Suspect secondary HTN if

–        Onset is <20 yrs or >50yrs.

–        Difficult to control(refractory) HTN.

–        Previously controlled HTN getting uncontrolled.

–        TOD @ detection of HTN

l      Causes of secondary HTN

–        Renal

l      AGN, Renal failure, ADPKD, RAS.

–        Endocrine

l      Cushing's, Pheo, thyrotoxicosis,

Conn`s syndrome, Acromegaly..

–        Drugs

l      NSAID, Steroids, OCP..

–        COA

–        PIH

–        Alcohol

–        Inv: Hb-11 g%, ESR 40 @ 1 hr.

–        Urine Alb +, 4-5 RBC/HPF, no casts.

–        B urea26 mg%,  creat 1.2 mg%, RBS 97 mg%, s Na136meql, S K 3.8 meqL

–        ECG - LVH  & CXR wnl.

–        Usg: B/L nephromegaly (16 & 14 cm.) with numerous   thin walled anechoic cysts of    5-30mm  size. No calculi, hydro nephrosis.

    3 cysts were seen in the rt lobe of liver.

                            sug of ADPKD.

l      ADPKD, Secondary HTN, with LVH.

l      HTN controlled with  Enalapril, Amlodipine & Methyl dopa.

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