A rare cause of secondary arterial hypertension

Abstract

A RARE CAUSE OF SECONDARY ARTERIAL HYPERTENSION Introduction: Familial amyloid polyneuropathy (FAP) type 1, better known in Portugal as "Doença dos Pezinhos", is a heredita- ry form of amyloidosis caused by the accumulation of a mutant protein (transthyretin). It is a rare disease which may be diffi- cult to diagnose when there is no previous family history of the condition. Case description: This report describes the case of a 60-year-old Caucasian woman with a history of hypothyroidism, dyslipi- demia, hyperuricemia, mixed anxiety and depressive disorder, chronic venous disease of the legs and hypertension. In June 2009, she was seen for the first time by her new family doctor, with laboratory results that showed proteinuria. A 24-hour urine col- lection for microalbuminuria and a renal scan were obtained. A diagnosis of chronic renal failure was made. The patient was re- ferred for a nephrology consultation in a central hospital where additional tests were done to determine the cause of her ill- ness. In August 2010, she was hospitalised in the nephrology unit with rapidly progressive renal failure with nephrotic protei- nuria. A renal biopsy showed familial amyloidosis, Portuguese type (ATTR). She was then referred to the familial amyloid poly- neuropathy clinic in another hospital. Comment: This case report shows the importance of adequate investigation in a patient with arterial hypertension. It also shows how rare causes may be considered in common clinical syndromes.