REFRACTORY HYPOKALAEMIA IN PREGNANCY: AN UNUSUAL PRESENTATION OF RENAL ARTERY STENOSIS
Dr Isra Iftikhar1
1Sir Charles Gardiner Hospital, Perth, Australia
Background: Renal artery stenosis (RAS) is an unusual cause of refractory hypertension and hypokalaemia in pregnancy.1 Management can be challenging but centres around maternal blood pressure control with consideration of antepartum renal artery angioplasty.
Case report: A 40-year-old woman presented to the emergency department at 7 weeks gestation with a short history of nausea and vomiting. Shortly after arrival, she had a hypokalemic cardiac arrest (initial potassium 2.4mmol/L, normal range 3.5-5.0). Following successful resuscitation, her management was complicated by hypertension and refractory hypokalaemia. Magnetic resonance angiography demonstrated at the right renal artery a long segment of stenosis, consistent with fibromuscular dysplasia.
Her blood pressure and potassium levels stabilised with high dose oral potassium supplementation, spironolactone and amiloride. Invasive angiography or renal artery angioplasty were not pursued during pregnancy due to maternal clinical stability.
The rest of her pregnancy was uncomplicated with delivery of a 3.16 kg baby at 38 weeks gestation.
Post-partum, she was persistently hypertensive and underwent right renal artery angioplasty. Following this procedure, she still required three antihypertensive agents but was able to cease potassium supplementation.
Conclusions: In cases of severe, early onset or medication refractory hypertension during pregnancy, clinicians should consider investigating for RAS along with other causes of secondary hypertension,.2,3
Outcomes are variable, with high rates of maternal hypertension, preeclampsia, fetal loss and preterm birth.1,4,5 Management centres around maternal blood pressure control with consideration of antepartum renal artery angioplasty. Intervention is indicated in the setting of early onset hypertension that is unable to be controlled with medical management, deterioration in maternal renal function or where the benefit of intervention is felt to outweigh potential harms to the fetus and mother.6
Biography:
Isra Iftikhar is a first-year renal advanced trainee from Sir Charles Gairdner Hospital, Western Australia. In addition to renal medicine, she has a long-standing interest in medical education. She is dual training in General Medicine and Nephrology. This is her second time attending the ANZSN ASM.