CARDIORENAL CONSEQUENCE IN A CHILD WITH LATENT HEPATITIS B

Abstract

Objective: Approximately 20% of patients with HBV infection have a wide range of extrahepatic damages that include renal and cardiovascular abnormalities. The purpose: is to highlight the cause of hypertension in a child with viral hepatitis B and multiorgan damage. Design and method: Describing a clinical case of a child with occult hepatitits. Results: A 1-year-old girl with toxic syndromes was hospitalized in Pediatric Department. Anamnestic data: the mother was diagnosed with HBsAg positive 4 years ago. The child was vaccinated with all 4 scheduled doses of anti-HBV vaccine. At first examination - increased BP values (160–220/100–120 mm/Hg), tachycardia, hepatomegaly. Laboratory tests: anemia gr. II, hypoproteinemia, hypoalbuminemia, hypocalcemia, slightly elevated transaminases. Ecocardiography - cardiac remodeling with dilated lef ventricle (LV); hypokinesia, and mild hypertrophy of interventricular septum; LV ejection fraction - 47%. The secondary causes of arterial hypertension have been investigated: concentration of fractionated urinary and plasma metanephrines - N, direct plasma renin - > 5000 UI/mL, and serum aldosterone - 128 ng / dL. The aldosterone/renin ratio was 0.025 - suggestion of renal ischemia with secondary hyperaldosteronism. Cardiac and abdominal angioCT - severe hypoplasia of the common hepatic artery, moderate diffuse stenosis of the abdominal aorta at the renal and infrarenal levels, moderate diffuse stenosis of the bilateral renal arteries, more pronounced on the right, bilateral renal atrophy changes; cateterism cardiac - the aorta is permeable throughout, stenosis on the renal arteries, celiac trunk, and mesenteric artery was not determined, data that allowed the exclusion of the renovascular cause of hypertension. Abdominal MRI - focal areas 7x8 mm of diffusion restriction in the bilateral renal parenchymal. The patient was suspected of an HBV infection with a risk of perinatal transmission, after in dynamics, there was identified hepatomegaly (+3.0 cm) and elevated ALAT and ASAT. Quantitative plasma HBV DNA -1 418 771 300 copies/ml or 834 571 352 IU/ml, which confirmed the diagnosis - Occult viral hepatitis B, gr. III of activity, seropositive form, with extrahepatic cardiorenal impairment. Conclusions: Cardiorenal impairment should be suspected in patients with HBV infection, especially in presence of clinical signs.