Endocrine Abstracts

Introduction

Hypertension is a frequent finding amongst people having either Type1 or Type 2 diabetes. In Type 2 diabetes, hypertension is present in a great number of persons, at the time of diagnosis but it’s occurrence is low with the diagnosis of Type 1 diabetes.

Case presentation

A 34 years old Saudi male, non-smoker, had been following up at our University Diabetes Center since February, 2020. He had Type1 diabetes for 23 yrs, hypertension for 2 yrs, chronic kidney disease G4A2 and vitamin D deficiency with secondary hyperparathyroidism. The patient had a strong family history of hypertension & diabetes. There was no previous history of ketoacidosis or any other illness. Systemic review unremarkable. The patient had Stage 2 Hypertension, as per office & home BP readings, despite being compliant to all antihypertensives. He was on Basal bolus insulin, Angiotensin receptor blocker, B-blocker, Calcium channel blocker, hydrochlorthiazide, Spironolactone and Cholecalciferol replacement. Exam-BP 160/90 mmHg with no postural drop, pulse 72/m, regular, RR 20/m, afebrile, O2sat 99%. BMI 32.93 kg/m². Rest of the general and systemic exams unremarkable.

Investigations

(25.11.20) Normal CBC(Hb% 14 g/dl), liver & thyroid parameters. BUN 10 mmol/l(10–6.4), Creatinine 239 µmol/l(62–115), eGFR(EPI)–29 ml/min, Albumin:Creatinine 161.33 mg/g(0–30), HbA1c 8.2%(4.3–5.8), Bone profile(corrected S.Ca++2.41 mmols/l(2.1–2.55), 25-OH Cholecalciferol 27 nmol/l(75–250), PTH 18.24 pmol/l(1.6–6.9). Rest normal). Aldosterone:Cortisol 0.07(0.1–3.7). CXR & ECG normal. Echocardiogram-mild concentric left ventricular hypertrophy & moderate LA enlargement. US renal arteries doppler-normal. The patient was referred to the Nephrology clinic for further management.

Conclusions

Chronic kidney disease in people with diabetes increases the chances of resistant hypertension. Resistant hypertension runs parallel to the worsening renal parameters i.e.eGFR and albuminuria.