Síndrome poliuria - polidipsia de causa autoinmune en el posparto de una mujer de 27 años

La hipofisitis autoinmune es un cuadro caracterizado por la infiltración linfocítica de la hipófisis que produce deficiencia de una o más hormonas, tanto de la adenohipófisis como de la neurohipófisis. Para el diagnóstico, es necesario un alto índice de sospecha, más aún considerando la relación temporal con el embarazoo el parto. Las características clínicas e imagenológicas sugieren el diagnóstico. A pesar que el diagnóstico definitivo es por biopsia, esta no se suele realizar por los potenciales efectos adversos del procedimiento. Presentamos un caso que describe la forma de manifestación de la enfermedad y las características imagenológicas típicas en la resonancia magnética nuclear.

Autoimmune hypophysitis is a condition characterized by lymphocytic infiltration of the pituitary resulting in deficiency of one or more hormones of both the adenohypophysis and the neurohypophysis. For diagnosis, a high index of suspicion is necessary, even more so considering the temporal relationship with pregnancy or childbirth. Clinical and imaging features are suggestive of the diagnosis. Although the definitive diagnosis is by biopsy, this is not usually performed because of the potential adverse effects of the procedure. We present a case describing the form of manifestation of the disease and the typical imaging features on magnetic resonance imaging.

A Case of Unrecognized Psychogenic Polydipsia

@#Psychogenic polydipsia is prevalent among people with schizophrenia. Although its pathophysiology is relatively unknown, it causes life threatening complications due to acute or severe hyponatraemia.. This report illustrates a patient with schizophrenia who had unrecognized psychogenic polydipsia and developed severe complication. It also highlights the clinical salience of its management.

Polydipsia as a Precursor of Manic Episode in Bipolar Affective Disorder Patients with Alcohol Use Disorder

Bipolar affective disorder (BD) diagnosis and initiation of appropriate treatment are often delayed, and this is associated with poorer outcomes, such as rapid cycling or cognitive decline. Therefore, identifying certain warning signs of a probable successive episode during the inter-episode phase is important for early intervention. We present the retrospective data of three cases of BD. Our first case had a history of alcohol use disorder (AUD), where he drank in a dipsomaniac manner, and the other two cases had dipsomaniac alcohol use before their manic attacks, and none of them had any AUD after the mood episode was over. Two brothers also had hypertensive episodes during the manic attacks. None of the cases reported increased fluid intake when they were euthymic. We suggest that polydipsia in BD may be a warning sign of an upcoming manic episode, especially in those patients with AUD. Polydipsia in BD may be caused or facilitated by a combination of hyperdopaminergic activity, hypothalamic dysfunction, and dysregulated renin-angiotensin system. To be able to prevent new episodes, a patient’s drinking habits and change in fluid intake should be asked at every visit. Those patients with a history of alcohol abuse should especially be informed about polydipsia and manic episode association.

Primary Polydipsia in Children: Two Case Reports

Primary polydipsia (PP) is marked by an increase in thirst, and most often presents in patients with psychiatric illnesses. Although uncommon in children, we experienced cases of PP in a 15-month-old boy and a 5-year-old girl. Both were admitted to the hospital with symptoms of polydipsia and polyuria that appeared 1–3 months before admission. Brain magnetic resonance imaging in both patients was normal. A water restriction test was performed after hospitalization and showed normal results. The symptoms improved after the parents were instructed to implement water-intake restriction for 2 weeks. Our report provides useful information for the treatment of PP in children.

Psychogenic polydipsia and hyponatremia – A side effect of psychosis: a review with a case report / Polidipsia psicogênica e hiponatremia – Efeito colateral da psicose: revisão com relato de caso

ABSTRACT Primary polydipsia, or psychogenic polydipsia, is a condition that results in considerable morbidity and mortality. In psychiatric patients, psychogenic polydipsia and the syndrome of inappropriate antidiuretic hormone secretion may cause hyponatremia. In the 1970s, it was recognized that antipsychotics such as tiotixene and haloperidol could impair the excretion of a free water load. There are also several case reports of drug-induced hyponatremia in patients using atypical drugs suggesting that these probably can also impair water balance and induce hyponatremia. Case report and review of relevant literature are reported in this article. Psychogenic polydipsia is a common cause of hyponatremia among individuals with chronic mental illness. A case of severe hyponatremia caused by psychogenic polydipsia is described involving a female patient with an adult lifelong history of chronic mental illness diagnosed as schizoaffective disorder. After switching her antipsychotic medication to clozapine water ingestion was normalized as well as sodium levels and her psychotic symptoms improved. Primary polydipsia occurs commonly with schizophrenia and other mental diseases and can cause hyponatremia. PPD may present as an acute psychotic state or as inexplicable emergence of seizures. Appropriate, timely clinical assessment with special attention to thirst, fluid intake, and urine output is essential. Proper treatment may include drug withdrawal and fluid and saline restriction. Once corrected, some pharmacological agents can be tried. The article illustrates the importance of the diagnosis of psychogenic polydipsia given its electrolyte disturbances and life threatening situations.

RESUMO A polidipsia primária ou polidipsia psicogênica (PDP) é uma condição que se traduz em altas taxas de morbilidade e mortalidade. Nos doentes psiquiátricos, a PDP e a síndrome da secreção inapropriada do hormônio antidiurético (SIADH) podem resultar em hiponatremia. Nos anos 1970, foi reconhecido que alguns antipsicóticos como o tiotixeno e o haloperidol podiam comprometer a excreção de água livre. Existem ainda diversos casos reportados de hiponatremia iatrogênica em pacientes medicados com antipsicóticos atípicos sugerindo que essa classe farmacológica pode igualmente resultar em hiponatremia. Um caso clínico e uma revisão sobre o tema são reportados neste artigo. A polidipsia psicogênica é uma causa comum de hiponatremia entre os indivíduos com doença mental crônica. Um caso de hiponatremia grave causada por polidipsia psicogênica é descrito envolvendo uma paciente do sexo feminino com antecedentes de perturbação esquizoafetiva. Após alteração da sua medicação antipsicótica para clozapina, observou-se normalização na ingestão hídrica bem como nos níveis de sódio e melhoria da sintomatologia psicótica. A PDP ocorre comumente em doentes esquizofrênicos ou com outras perturbações psiquiátricas e pode resultar em hiponatremia. Um correto diagnóstico com especial atenção a sede, ingestão hídrica e débito urinário é essencial. O tratamento pode incluir a retirada de fármacos e restrição hídrica e salina. Uma vez corrigida, alguns agentes farmacológicos podem ser utilizados.

Polidipsia primaria y diabetes insípida parcial central: dos entidades no excluyentes / Primary polidipsia and partial central diabetes insipidous: two non-exclusive entities

Partial forms of diabetes insipidus (DI) can be combined sometimes with alterations in the functionality of antidiuretic hormone (ADH) as a result of other co-morbidities. These entities are sometimes combined, it being necessary to assess this possibility further diagnostic protocols in particular cases. If clinical patient is within the spectrum of a DI of neurohypophyseal origin is described.

SECTION A: Pathophysiology of Type 2 Diabetes Mellitus in Children. SECTION B: Clinical scenario of Type 2 Diabetes mellitus in children. SECTION C: Epidemiology and Prevention of Type 2 Diabetes mellitus in children.

SECTION A: Pathophysiology of Type 2 Diabetes mellitus in children Dr. Jyoti Kini While Type 2 diabetes mellitus (T2DM) continues to be a disease of the elderly and the middle aged, currently there has been an upsurge in the incidence of T2DM in the adolescents and the young. Family history, maternal gestational diabetes, low birth weight have contributory role to play in the pathophysiology of T2DM. The pathophysiology underlying the development of alterations in glucose metabolism ranging from abnormal fasting glucose (AFG) to impaired glucose intolerance (IGT) is multifactorial. The early onset of diabetes in childhood or adolescence heralds a long disease interval with resultant escalation of the probability of development of co-morbidities and the entire range of macro- and microvascular complications. SECTION B: Clinical scenario of Type 2 Diabetes mellitus in children Dr. Mallikarjungowda S Patil Type 2 diabetes mellitus (T2DM) is a heterogeneous disorder, characterized by peripheral insulin resistance and failure of beta cells to keep up with increasing insulin demand. T2DM children are usually obese, may present with mild symptoms of polyuria and polydypsia. A systemic approach for treatment of T2DM should be implemented according to the natural course of the disease, including adding insulin when oral hypoglycemic agents failure occurs. Life style modification is an essential part of management. When lifestyle interventions fail to normalize blood glucose, oral hypoglycemic agents are introduced for management of persistent hyperglycemia. SECTION C: Epidemiology and Prevention of Type 2 Diabetes mellitus in children Dr. Savindika Nawarathna , Dr. Animesh Jain Type 2 diabetes mellitus was considered rare amongst children, but recently the incidence has increased worldwide with almost half of the newly diagnosed cases being children and adolescents. Type 2 diabetes mellitus (T2DM) is primarily characterized by insulin resistance detected at the level of skeletal muscle, liver, and adipose tissues with a failure of β-cell compensation and a relative insulin deficiency. A variety of risk factors like race, obesity, insulin resistance, family history, psychococial factors, birth weight, exposure to maternal DM and breastfeeding can influence the development of T2DM. Type 2 DM screening in the paediatric population should be clinically focused and take into account not only those risk factors identified in the American Diabetes Association guidelines, but also the clinical context, pubertal status, and the results of simple screening measures such as fasting glucose and triglycerides. More outcome-based research is required before general screening, to identify children and adolescents with pre-diabetes or insulin resistance can be recommended. The pathophysiology underlying the development of alterations in glucose metabolism ranging from abnormal fasting glucose (AFG) to impaired glucose intolerance (IGT) is multifactorial. The early onset of diabetes in childhood or adolescence heralds a long disease interval with resultant escalation of the probability of development of co-morbidities and the entire range of macro- and microvascular complications.

Rabdomiólise recorrente secundária à hiponatremia em doente com polidipsia psicogênica primária / Recurrent rhabdomyolysis secondary to hyponatremia in a patient with primary psychogenic polydipsia

A rabdomiólise é caracterizada por destruição de tecido muscular esquelético, sendo as suas principais causas o trauma, os tóxicos e os distúrbios hidroeletrolíticos. Entre esses últimos, inclui-se a rabdomiólise induzida por hiponatremia, uma situação rara, que ocorre principalmente em doentes com polidipsia psicogênica. Esta acomete maioritariamente doentes com esquizofrenia, cursando com hiponatremia em quase 25% dos casos. É também nesse contexto que a rabdomiólise secundária a hiponatremia ocorre mais frequentemente. Neste artigo, descreveu-se o caso de um homem de 49 anos, com antecedentes de esquizofrenia, medicado com clozapina, trazido ao serviço de urgência por quadro de coma e convulsões. Foi objetivada hiponatremia hiposmolar grave, com edema cerebral em tomografia computorizada, sendo feito posteriormente o diagnóstico de hiponatremia secundária à polidipsia psicogênica. Foi iniciada terapêutica de correção de hiponatremia e internado em unidade de terapia intensiva. Feita correção de hiponatremia, contudo apresentou analiticamente marcada rabdomiólise, de agravamento crescente, com creatinofosfoquinase de 44.058UI/L no 3º dia de internação. Houve posterior redução progressiva com a terapêutica, sem ocorrência de lesão renal. Este caso alerta para a necessidade de monitorização dos marcadores de rabdomiólise na hiponatremia grave, ilustrando um quadro de rabdomiólise secundária à hiponatremia induzida por polidipsia psicogênica, situação a considerar em doentes sob terapêutica com neurolépticos.

Rhabdomyolysis is characterized by the destruction of skeletal muscle tissue, and its main causes are trauma, toxic substances and electrolyte disturbances. Among the latter is hyponatremia-induced rhabdomyolysis, a rare condition that occurs mainly in patients with psychogenic polydipsia. Psycogenic polydipsia mostly affects patients with schizophrenia, coursing with hyponatremia in almost 25% of the cases. It is also in this context that rhabdomyolysis secondary to hyponatremia occurs most often. In this article, the case of a 49-year-old male with a history of schizophrenia, medicated with clozapine, and brought to the emergency room in a state of coma and seizures is described. Severe hypoosmolar hyponatremia with cerebral edema was found on a computed tomography examination, and a subsequent diagnosis of hyponatremia secondary to psychogenic polydipsia was made. Hyponatremia correction therapy was started, and the patient was admitted to the intensive care unit. After the hyponatremia correction, the patient presented with analytical worsening, showing marked rhabdomyolysis with a creatine phosphokinase level of 44.058UI/L on day 3 of hospitalization. The condition showed a subsequent progressive improvement with therapy, with no occurrence of kidney damage. This case stresses the need for monitoring rhabdomyolysis markers in severe hyponatremia, illustrating the condition of rhabdomyolysis secondary to hyponatremia induced by psychogenic polydipsia, which should be considered in patients undergoing treatment with neuroleptics.

A Case Report: Irbesartan and Naltrexone Treatment of Polydipsia in a Patient with Schizophrenia / 대한정신분열병학회지

Polydipsia in schizophrenic patients is not uncommon, but a frequently underdiagnosed condition. The etiology of polydipsia remains unclear, and its complications can be life-threatening, while often being difficult to manage it. We report a case of a successfully treated chronic schizophrenic patient with polydipsia. The patient was male, 47-year-old, suffering 27-years of residual schizophrenia who had been consuming more than 10 L of water per day, and is complicated by hyponatremia. He was treated with irbesarten 300 mg and naltrexone 50 mg in the setting of closed ward. He consumed less than 3.5 L of water per day and serum sodium levels seemed to be stable following discharge from the closed ward. We suggest that irbesartan and naltrexone may have beneficial effects for treating polydipsia, and future prospective and well-controlled studies are to be performed.

Hypotonic hyponatremia by primary polydipsia caused brain death in a 10-year-old boy

Hypotonic hyponatremia by primary polydipsia can cause severe neurologic complications due to cerebral edema. A 10-year-and-4-month-old boy with a psychiatric history of intellectual disability and behavioral disorders who presented with chief complaints of seizure and mental change showed severe hypotonic hyponatremia with low urine osmolality (serum sodium, 101 mmol/L; serum osmolality, 215 mOsm/kg; urine osmolality, 108 mOsm/kg). The patient had been polydipsic for a few months prior, and this had been worse in the previous few days. A diagnosis of hypotonic hyponatremia caused by primary polydipsia was made. The patient was in a coma, and developed respiratory arrest and became brain death shortly after admission, despite the treatment. The initial brain magnetic resonance imaging showed severe brain swelling with tonsillar and uncal herniation, and the patient was declared as brain death. It has been reported that antidiuretic hormone suppression is inadequate in patients with chronic polydipsia, and that this inadequate suppression of antidiuretic hormone is aggravated in patients with acute psychosis. Therefore, hyponatremia by primary polydipsia, although it is rare, can cause serious and life-threatening neurologic complications.

Urinary Retention Accompanied by Retroperitoneal Urine Leakage in Schizophrenia

We presented a case of a 46-year-old man who attended the emergency department with right flank pain. Abdominal computed tomography showed dilated renal pelvis, ureter and distended bladder. Fluid collection was seen in retroperitoneal space and pelvic cavity. He had renal insufficiency. When a urethral catheter was inserted, 1,200 mL urine was drained. He was diagnosed with schizophrenia more than 20 years prior, and had been taking anti-psychotics. He had been living in a sanatorium. He had nocturnal enuresis and had worn an incontinence pad nightly for the last 10 years. His fluid consumption was 10 L/day. After placement of an indwelling urethral catheter for relieving voiding problems and restriction of fluid intake, fluid collection in retroperitoneal spaces and pelvic cavity was removed and renal insufficiency was recovered. After training of self-clean intermittent catheterization, he was discharged.

Pheochromocytoma Presenting as Diabetes Insipidus.

Background: Pheochromocytomas are catecholamine producing tumors that classically present with the triad of sweating, palpitations and headache. Case characteristics: 9- year-old boy whose only presenting complaints were polyuria and polydipsia for 2 years. Observation: Routine measurement of blood pressure detected mild hypertension, and subsequent investigations revealed bilateral pheochromocytoma. Outcome: Surgical removal of the tumors resulted in complete resolution of polyuria and polydipsia. Message: The case highlights the importance of measuring BP for children as part of physical examination.

Non-psychogenic polydipsia in 45-year-old man with primary hyperparathyroidism and recurrent bilateral nephrolithiasis.

Non-psychogenic polydipsia with hyponatremia is a rare clinical presentation. Primary hyperparathyroidism is a disorder of calcium, phosphate, and bone metabolism caused by increased level of parathyroid hormone (PTH). It is estimated the incidence of primary hyperparathyroidism are 21.6 per 100,000 person a year. This case report describe a 45-year-old man presented with non-psychogenic polydipsia. This patient drank a lot of water out of the fear of recurrent kidney stones. He had history of recurrent nephrolithiasis with hypercalcemia. We investigate further the cause of hypercalcemia and we diagnosed primary hyperparathryoidism as the cause.

<b>Two Cases in which Byakkokaninjinto was Effective for </b><b>General Malaise in Aging Males </b> / 日本東洋医学雑誌

We report 2 cases in which byakkokaninjinto was effective for general malaise in aging males. In 1939, climacterium disorders with general malaise were reported in aging men in America. Later, late-onset hypogo nadism (LOH) was defined, and guidelines for LOH syndrome were made.<BR>We distinguished two cases of climacterium disorder with LOH syndrome in aging males. We used the AMS score (which is a diagnostic criteria for LOH syndrome) at the first medical examination.<BR>Case 1 was a 48-year-old man suffering from serious headaches every day for which he took many analge sics. His AMS score was 27/85 at the first medical examination. Mild LOH syndrome was suspected in this case. Case 2 was a 48-year-old man suffering from frequent daily hot flashes. His AMS score was 42/85 and moderate LOH syndrome was suspected.<BR>General malaise in aging males arises from a decrease in male hormone with aging and is treated with an drogen hormone replacement therapy (androgen HRT), while Kampo treatment is also a consideration. As Kampo treatments, hachimijiougan and kamishouyousan are usually chosen. Byakkokaninjinto was effective these patients who showed thirst and polydipsia.

Diabete insípido central em um cão / Central diabetes insipidus in a dog

Descreve-se um caso de diabete insípido central em um cão, fêmea, nove anos de idade, sem raça definida, com história de poliúria e polidipsia há 18 meses. Com o exame físico, nenhuma alteração sistêmica foi elucidada. Já nos exames laboratoriais complementares, observou-se policitemia e hiperproteinemia, e a densidade específica da urina (1002) encontrava-se abaixo do limiar fisiológico. O animal foi submetido à privação hídrica e se mostrou incapaz de concentrar a urina durante as sete horas observadas, tempo que levou para apresentar 5 por cento de desidratação. Após isso, foi administrado acetato de desmopressina e, 5 horas após, a densidade estava em 1028, confirmando o diabete insípido de origem central. O animal recebeu terapia à base de acetato de desmopressina, apresentando melhora do quadro clínico.

A case of central diabetes insipidus in a nine-year-old female dog is described. The dog presented intermitent polyuria and polydipsia in the past 18 months. In the clinical exam, complete blood count, alanine transaminase, alkaline phosphatase, BUN, creatinine, glucose and calcium dosages were normal. However, the specific urine gravity was low and presented the value 1002. The dog was unable to concentrate the urine during the seven hours of water deprivation test and presented 5 percent of dehydratation. The administration of desmopressin acetate elevated the specific urine gravity to 1028 five hours after the beginning of the treatment, confirming the diagnosis of diabetes insipidus of central origin.

Prevalence and Risk Factors of Polydipsia and Water Intoxication in Psychiatric Inpatients

OBJECTIVES: The aims of this study are to estimate the prevalence of polydipsia and water intoxication and to identify risk factors of polydipsia and water intoxication in psychiatric inpatient. METHODS: 1,108 Psychiatric inpatients at 2 mental hospitals in Yongin city were studied from September, 2008 to January, 2009. We diagnosed'polydipsia' using staff reports(fluid intake>3L/day) or by specific gravity of urine(SPGU4%). We attempted to identify clinical characteristics of patients by reviewing their medical records. RESULTS: Two hundred forty seven patients(22.3%) were polydipsic. Sixty eight patients(6.1%) were at risk for water intoxication. The factors associated with polydipsia were lithium, smoking, younger age and increased smoking amounts. The factors associated with risk for water intoxication were valproic acid and polydipsia. CONCLUSION: Polydipsia and water intoxication in psychiatric inpatients are not rare conditions. Therefore, clinicians' attention should be paid to these conditions.

Efficacy of Clozapine on Schizophrenia with Polydipsia: Two Cases Experience / 대한정신약물학회지

Polydipsia occurs frequently in chronic schizophrenic patients, some of whom develop hyponatremia. Although the underlying pathophysiology of polydipsia among psychiatric patients, recent reports indicate that clozapine treatment improves polydipsia-hyponatremia in schizophrenia. Two schizophrenic patients with polydipsia, followed for more than two years, showed improvement on clozapine. Case 1 was a patient without history of hyponatremia who improved from polydipsia and psychosis. Case 2 was an inpatient with polydipsia and hyponatremia who showed improvement of polydipsia and did nor recur hyponatremia. The limited information provided by these case reports suggest the need for controlled studies of the clozapine effect on schizophrenic patients with polydipsia.

Pituicytoma: Case Report

We report a case of Pituicytoma, which is a rare brain tumor occuring in the sellar region. A 44-year-old woman presented with polyuria, polydipsia, visual disturbance, amenorrhea and galactorrhea 1 year prior to admission. A magnetic resonance image revealed a well enhancing pituitary mass with large suprasellar extension. There was no area of normal hyperintensity showing the posterior lobe of the pituitary gland. The tumor was subtotally removed via transsphenoidal surgery. Pathological examination of the surgical specimen showed astrocytes with spindle-shaped fibrillary cytoplams. Immunohistochemical staining was positive for glial fibrillary acidic protein, S-100, vimentin. Radiotherapy was not given after surgery.

Effects of Fluoxetine on Tyrosine Hydroxylase Expression in Schedule-Induced Polydipsia Rats / 신경정신의학

OBJECTIVE: It has been suggested that fluoxetine inhibits the dopaminergic neurotransmission by serotonergic mediation. And also, it has been shown to inhibit synthesis of DOPA in dopamine-rich areas of the rat forebrain. These dopamine-antagonistic capacity of fluoxetine is only supported by anecdotal report that the increased amount of motor disability in patients with idiopathic Parkinson's disease after exposure to fluoxetine. However, there is still no evidence of the direct effect of fluoxetine on dopaminergic neuronal cell body in the substantia nigra, VTA, caudate & putamen. This study was designed to evaluate the effects of fluoxetine in rat brain which showed decreased numbers of dopaminergic neuronal cell body induced by schedule-induced polydipsia(SIP). METHODS: We incidentally found that 4 weeks of schedule-induced polydipsic rats revealed the suppression of tyrosine hydroxylase expression in the substantia nigra, VTA, caudate & putamen with the immunohistochemistric measures. After 3 weeks of intraperitoneal injection of 10mg/kg of fluoxetine to the schedule induced polydipsic rats, the tyrosine hydroxylase expression was also measured with immunohistochemistry. We compared the tyrosine hydroxylase expression among the normal control, the polydipsic rats, and the rats with fluoxetine treatment. RESULTS: 1) By contrast with the control, the polydipsic rats revealed the evidence of decreased tyrosine hydroxylase expression in the substantia nigra, VTA, caudate & putamen. 2) After daily injection of fluoxetine for 3 weeks, the polydipsic rats showed increment of tyrosine hydroxylase expression in those areas. CONCLULSION: In previous studies, a great deal of results suggest that fluoxetine negatively influence the dopaminergic systems indirectly via serotonergic activation such as inhibition of dopamine synthesis or transport system. Although our results are obtained from rodents, we suggest that fluoxetine directly and positively enhance the dopamine system in the substantia nigra, VTA, caudate & putamen. The chronic adminstration of fluoxetine may be helpful to dopamine-depleted condition in clinical situations. We anticipate the replication studies of our findings and well-controlled clinical trial.

Hyponatremia, polyuria-polydipsia and renovascular hypertension in a child: An unusual clinical manifestation.

We reported a 3 1/2 years old child presented with history of sudden onset of polyuria-polydipsia with severe hypertension (210/90 mmHg). His initial laboratory work up revealed hyponatremia, marked natriuresis, kaliuresis, and nephrotic range of proteinuria. His echocardiogram showed evidence of moderate to severe left ventricular hypertrophy compatible with long standing hypertension. Captopril renoscintigraphy (Tc99m-EC) suggested grade III right renal artery stenosis. Renal angiography revealed total occlusion of his right renal artery with collateral artery from the left renal artery. The lesion was not suitable for balloon angioplasty. He continued to have severe hypertension despite being treated by five different anti-hypertensive medications. Right nephrectomy was performed. During the recovery period his blood pressure and plasma electrolyte returned to normal. Normal excretion of sodium and protein were also seen in his urine. We suggest that renovascular hypertension should be considered and promptly investigated in a child presented with hypertension association with hyponatremia, hypokalemia, and polyuria-polydipsia.