Hypertensive encephalopathy secondary to acute postinfectious glomerulonephritis
Keywords:
hypertensive encephalopathy, posterior leukoencephalopathy, glomerulonephritis, nephritis, high blood pressureAbstract
Introduction: Hypertensive encephalopathy is a syndrome of brain dysfunction due to loss of self-regulation, caused by an acute elevation of blood pressure. Most hypertensive crises in children are due to secondary causes. The most common are renal disorders, such as acute post-infectious glomerulonephritis, which is characterized by an immune-type glomerular inflammatory lesion following an infection. Hypertensive encephalopathy occurs in 1 to 7 % of cases in the course of this disease.
Objective: To describe a paediatric patient, with a picture of hypertensive encephalopathy secondary to acute post-infectious glomerulonephritis.
Clinical case: A 7-year-old male patient, asthmatic, with a history of untreated pyodermitis 15 days earlier, presented to the emergency department with focal seizures in status, sustained headache and edema. Severe hypertension and microhematuria were found on evaluation. The discharges with anticonvulsants subsided and the patient was admitted to progressive care with suspected hypertensive encephalopathy secondary to acute post-infectious glomerulonephritis. Examinations confirmed the presumptive diagnosis. He received immediate treatment according to protocols with favorable evolution. The patient was discharged after 7 days with follow-up by outpatient consultation.
Conclusions: Acute postinfectious glomerulonephritis usually presents as a nephritic syndrome, but its complications should not be underestimated. Hypertensive encephalopathy may present with this disease, hence the importance of measuring blood pressure in children as part of the physical examination. Its timely diagnosis and treatment are the key to a favorable evolution, without neurological sequelae.
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