An interesting case of pulmonary hypertension in nephrotic syndrome due to amphetamine use for attention-deficit hyperactivity disorder

Abstract

Pulmonary arterial hypertension (PAH) was first associated with stimulants use in the 1960s during an outbreak of amphetamine-like appetite suppressants (anorexigens). To date, various drugs and toxins have been correlated with PAH. Diagnosing PAH in nephrotic syndrome has always remained a challenge due to the overlap of signs and symptoms in clinical presentation between the two entities.

Case presentation: In this report, the authors present an interesting case of a 43-year-old male, diagnosed with nephrotic syndrome secondary to minimal change disease, as well as currently presenting with PAH secondary to amphetamine.

Clinical discussion and conclusion: Patients with nephrotic syndrome and end-stage renal disease should be regularly followed up and evaluated for comorbidities, complications, as well as adverse events from pharmacological intervention. In patients with end-stage renal disease hypertension control is key, stimulant use can precipitate poor blood pressure control especially in pulmonary arteries resulting in PAH. PAH can result in right ventricular dysfunction and heart failure that can further exacerbate renal dysfunction and vice-versa in a vicious cycle, deteriorating patient condition and quality of life.

Keywords: ADHD; amphetamine; end-stage renal disease; minimal change disease; nephrotic syndrome; pulmonary arterial hypertension.

Figure 1

Right bundle branch block pattern observed in the ECG obtained on presentation.

Figure 2

Echocardiographic findings revealing severe dilation of the main right ventricle (RV) and RV outflow tract, significant RV hypertrophy, severely reduced RV systolic function, severe right atrial dilation, severe tricuspid regurgitation, and elevated central pressures.