This 36 year old lady, a police officer, has been coming to the clinic for about six years now following a diagnosis of high blood pressure made during her last pregnancy. I thought she was rather young to have suffered from hypertension, yet pregnancy-induced hypertension is not unusual and many women continue having the condition well after their delivery.
When I first saw her she has been an "established hypertensive" with long-term prescription of drugs to keep her blood pressure within normal limits. I simply continued her treatment and kept her on my follow-up list. I normally make small talks with my patients on their health and she told me of being frequently tired which she attributed to her work. I also noted that in her earlier medical notes her blood pressure has not really been satisfactorily controlled despite high doses of drugs and her supposed compliance.
I thought of a possible deterioration of her kidneys due to prolonged hypertension which may not have been optimally controlled. I decided to order a simple test that was urine analysis. Her urine was found to have a significant presence of blood so microscopic that she has never complained about it. I repeated the test some time later, taking care that she was not in menses, and the same finding was reported.
Blood in the urine could mean a few things, an infection, a structural damage due to hypertension or autoimmune disease or a growth. I then proceeded with a KUB (xray of kidney/ureter/bladder) which showed nonspecific opacity above her left kidney and an ultrasound was later undertaken which confirmed a big mass sitting just above the kidney. Could it be an adrenal mass (adenoma) releasing excess hormone (aldosterone) causing high blood pressure? If this is so ,then by surgically removing the growth, her blood pressure should return to normal and there is no need for those cumbersome drugs! At this stage I referred her to see a kidney specialist (nephrologist) and a hormone specialist (endocrinologist).
Fancy what a simple urine test could do?
When I first saw her she has been an "established hypertensive" with long-term prescription of drugs to keep her blood pressure within normal limits. I simply continued her treatment and kept her on my follow-up list. I normally make small talks with my patients on their health and she told me of being frequently tired which she attributed to her work. I also noted that in her earlier medical notes her blood pressure has not really been satisfactorily controlled despite high doses of drugs and her supposed compliance.
I thought of a possible deterioration of her kidneys due to prolonged hypertension which may not have been optimally controlled. I decided to order a simple test that was urine analysis. Her urine was found to have a significant presence of blood so microscopic that she has never complained about it. I repeated the test some time later, taking care that she was not in menses, and the same finding was reported.
Blood in the urine could mean a few things, an infection, a structural damage due to hypertension or autoimmune disease or a growth. I then proceeded with a KUB (xray of kidney/ureter/bladder) which showed nonspecific opacity above her left kidney and an ultrasound was later undertaken which confirmed a big mass sitting just above the kidney. Could it be an adrenal mass (adenoma) releasing excess hormone (aldosterone) causing high blood pressure? If this is so ,then by surgically removing the growth, her blood pressure should return to normal and there is no need for those cumbersome drugs! At this stage I referred her to see a kidney specialist (nephrologist) and a hormone specialist (endocrinologist).
Fancy what a simple urine test could do?
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