SUN-171 HORSESHOE KIDNEYS: A CASE REPORT

Abstract

According to the World Health Organization, hypertension causes 7 million deaths every year while 1.5 billion people suffer due to its complication. Hypertension can be primary or secondary. Secondary type of hypertension can be seen in young patients with an acute rise or increase in blood pressure lability from a previous stable state. The most common cause of secondary hypertension is primary hyperaldosteronism. There has been limited data regarding the development of secondary hypertension among patients with renal fusion abnormalities. Horseshoe kidneys(HSK) is the most common fusion anomaly but it only accounts to about 0.25% of the population. The most common complications of HSK are infection, renal stone formation and ureteropelvic obstruction. There was only one case report of a patient with HSK and ureteropelvic obstruction who developed arterial hypertension and for this case, it is rare for a young patient with HSK to present with hypertension with no evidence of renovascular stenosis nor hydronephrosis. This is a case of a 23 year old male, Filipino, known hypertensive for 8 years, who came in for work up of recurrent palpitations. Work up for hypertension was done with significant finding of horseshoe kidneys with nephrolithiases on renal angiogram and atrial fibrillation on ECG. Initially patient was asymptomatic but eventually experienced exertional dyspnea thus underwent electrical cardioversion for the cardiac arrhythmia, converting it to sinus and was also advised for surgical intervention for the nephrolithiases. Currently patient is asymptomatic, no recurrence of palpitation was noted nor dyspnea with maintenance medications: Losartan+amlodipine 100mg/10mg 1 tablet once a day, apixaban 5mg/tablet 1 tablet once a day and flecainide 100mg/tablet 1 tablet once a day. The importance of initiating blood pressure control in a young hypertensive patient cannot be overemphasized because the opportunity to prevent the various complications associated with hypertension exists early in its course hence lessening the progression of end organ damage.