Renoparenchymal hypertension in a child with reactivated viral hepatitis B

Abstract

Introduction. The pathology of the renal parenchyma is the most common cause of drug-resistant malignant hypertension, being 5-10%. HBV-associated nephropathy is the most common extrahepatic clinical manifestation of HBV, the main pathogenetic mechanism being that mediated by circulating immune complexes. Purpose. Highlighting the difficulties of diagnosis of the cause of hypertension in a child with reactivated occult viral hepatitis B and renal impairment. Material and methods. The authors present the clinical case of a 1-year-old patient diagnosed with renoparenchymal malignant hypertension and reactivated occult viral hepatitis B, with very high viremia and extrahepatic affecting (cardiovascular, renal and cerebral). Results. The patient was hospitalized with clinical manifestations of toxic and infectious syndrome and blood pressure up to 200/120 mmHg. The clinical and paraclinical investigations have estimated stage I hypertensive retinopathy, leukocytosis with neutrophilia, increased acute phase reactants, hypoproteinemia, hypoalbuminemia, nephritic syndrome, marked hepatocytolysis and quantitative HBV DNA with extremely high values. The echocardiography revealed signs of cardiac remodeling and LV myocardial hypokinesia. Selective aortography ruled out the renovascular cause of hypertension. MRI revealed inflammatory changes in the bilateral renal parenchyma (Fig.2) and diffuse abdominal lymphadenopathy. Conclusions. The holistic approach of the patient allowed the identification of the possible cause of hypertension and inflammatory changes in the bilateral renal parenchyma as well as the premise for starting antiviral therapy.