Successful treatment of refractory hypertension with bilateral nephrectomy in a patient with chronic kidney disease stage 3.

We present a case of life-threatening refractory hypertension (rHTN) in a patient with stage 3b chronic kidney disease that was unresponsive to open surgical renal denervation (RDN) but responded to bilateral nephrectomy (BLN). Both RDN and BLN reduce the increased sympathetic activation in rHTN. However, RDN has yet to show reductions in blood pressure adequate for the average patient with rHTN, and BLN has thus far been reserved for patients with preexisting end-stage kidney disease (ESKD). Our case suggests that there are patients with rHTN that warrant consideration of BLN prior to developing ESKD.

Guillain-Barré syndrome hyponatremia: is it SIADH or pseudohyponatremia?

Approximately 5% of hospitalized patients with Guillain-Barré syndrome (GBS) experience SIADH; but pseudohyponatremia has also been reported in patients treated with IVIG. We present a case of a 51-year-old male with GBS who developed acute hyponatremia the day after initiation of IVIG; his sodium levels began to improve within 24 h of completion of IVIG. Differentiating between pseudohyponatremia caused by the IVIG treatment and SIADH caused by GBS was the key to successfully treating this patient. This case exemplifies the importance of pursuing further studies to determine the exact cause of hyponatremia in GBS in order to prevent further neurologic damage to the patient.