• Yael Kovalski, Roxana Cleper, Irit Krause, Benjamin Dekel, Alexander Belenky, and Miriam Davidovits.
• Institute of Pediatric Nephrology, Schneider Children's Medical Center of Israel, Petach Tikva, 49202, Israel.
• Pediatr. Nephrol. 2012 Jun 1; 27 (6): 1037-40.

BackgroundHyponatremic hypertensive syndrome (HHS) is characterized by unilateral renal artery stenosis with secondary hypertension and glomerular and tubular dysfunction due to hyperfiltration and activation of the renin-angiotensin system (RAS).Case Diagnosis/TreatmentWe describe four children with HHS. All presented with polyuria and polydipsia, electrolyte disturbances, metabolic alkalosis, variable tubular dysfunction, and nephrotic range proteinuria along with hypertension. Interestingly, in one patient, glomerular and tubular abnormalities preceded the development of hypertension. All symptoms resolved after the underlying renal ischemia was corrected by percutaneous angioplasty.ConclusionHyponatremic hypertensive syndrome may be more common in children than previously thought. Clinicians should be alert of the signs and symptoms because cure is possible with timely diagnosis and treatment.

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