Transient Hypertension with Hypertensive emergency in

Author: Jyoti Sharma

Question
A 15 year old adolescent presented with history of generalized swelling, which started with periorbital puffiness that progressed cephalocaudaly and hematuria for 5 days prior to admission.He had no prior history of sore throat pyoderma, headache, blurring of vision or altered sensorium. On examination he had facial puffiness, pedal and abdominal wall edema.His Blood Pressure was 170, 100,plus, - 10 mm of Hg in three readings over 1st two hours of admission.{stage 2 hypertension for his age,sex and height} Fundus examination was normal.On blood analysis his serum urea and
creatinine were 85 mg percent and 1.1mg percent{ More than 1mg percent} respectively. Serum electrolytes, serum
proteins and lipid profile were within normal limits.Antisreptococcal antibody titre was
raised markedly and serum C3 level was drastically reduced. On urinalysis,RBC count
was 250, ml,proteins 4plus and leucocytes 100, ml.Ultrasonography of abdomen revealed
increased cortical echo texture of both the kidneys suggesting medical renal disease. In view of above evidence diagnosis of post-streptococcal glomerulonephritis was made. In relation to this I have the following queries to make:-
1} As this adolescent is having transient stage 2 Hypertension and renal dysfunction which is present in majority of PSGN patients, shall we categorise him to the hypertensive emergency as mentioned by Bagga el,a l{1} or hypertensive urgency.
2}If it is to be categorized as hypepertensive emergency,shall we treat this with calcium
channel blockers and frusemide or aggressively in PICU with intravenous antihypertensive drugs i.e. Sodium Nitroprusside or Labetalol under constant
monitoring.{2}

REFERENCES
1}Bagga A, Jain R, Vijayakumar M, Kanitkar M, Ali U. Evaluation and management of
hypertension. Indian Pediatr.2007`44:103-21.
2}S Dinesh,A Olugbenga,Y Ihor,E Samer.Emergency management of Hypertension in
children.Int J Nephr 2012`10:1155-70

As the hypertension is of transient nature, what is the correct approach for categorization

Answer Discussion :

TAUQIR KHAN