{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T11:44:21Z","timestamp":1788090261020,"version":"build-2803163510"},"reference-count":7,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 1","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Refractory hypertension in young adults warrants evaluation for secondary causes. Chronic nonsteroidal anti-inflammatory drug (NSAID) use, though common, is an underrecognized cause of chronic kidney disease that may lead to biochemical abnormalities, including electrolyte disturbances and hormonal dysregulation. A 37-year-old male presented with headache, vomiting, and abdominal pain. Examination revealed severe hypertension (210\/190 mmHg) with epigastric tenderness. Electrocardiography (ECG) showed a Wellens type A pattern with Q waves. Initial laboratories revealed hyponatremia, hypokalemia, and deranged renal function. Despite correction of hyponatremia by day 4, hypokalemia persisted. Investigations revealed elevated aldosterone (37.4 ng\/dL) with normal renin (16.9 ng\/mL), significant proteinuria (24-h urinary protein: 2.58 g\/day), and low creatinine clearance (27 mL\/min\/1.73 m\n                    <jats:sup>2<\/jats:sup>\n                    ). Imaging showed bilaterally small kidneys with loss of corticomedullary differentiation, ruling out renal biopsy. Persistent hypokalemia was refractory to supplementation due to NSAID-induced gastritis. Elevated intact parathyroid hormone (193 pg\/mL) and Vitamin D deficiency indicated secondary hyperparathyroidism. Upon detailed history, the patient admitted to chronic NSAID use. A diagnosis of NSAID-induced acute-on-chronic interstitial nephritis with secondary hyperaldosteronism and hyperparathyroidism was made. Management included antihypertensives (labetalol, nicardipine, and prazosin), potassium correction, and withdrawal of NSAIDs. This case highlights the importance of thorough history taking and evaluation of secondary causes in young-onset refractory hypertension. Chronic NSAID use can precipitate progressive renal dysfunction, leading to complex metabolic and endocrine complications, including secondary hyperaldosteronism and hyperparathyroidism.\n                  <\/jats:p>","DOI":"10.4103\/aam.aam_401_25","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T02:00:08Z","timestamp":1769479208000},"page":"S103-S106","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["A Rare Presentation of Chronic Nonsteroidal Anti-inflammatory Drug-induced Acute-on-chronic Kidney Disease with Secondary Hyperaldosteronism and Hyperparathyroidism in a Young Male with Refractory Hypertension"],"prefix":"10.4103","volume":"25","author":[{"given":"Pradnya Mukund","family":"Diggikar","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Janani","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akhilesh","family":"Jagirdar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaivan Urmil","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"R1-20260819","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1517\/14740338.4.4.689","article-title":"Drug-induced nephropathy: An update","volume":"4","author":"Perazella","year":"2005","journal-title":"Expert Opin Drug Saf"},{"key":"R2-20260819","doi-asserted-by":"crossref","first-page":"13S","DOI":"10.1016\/S0002-9343(99)00113-8","article-title":"Nephrotoxicity of nonsteroidal anti-inflammatory drugs: Physiologic foundations and clinical implications","volume":"106","author":"Whelton","year":"1999","journal-title":"Am J Med"},{"key":"R3-20260819","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s40292-020-00415-9","article-title":"Practice recommendations for diagnosis and treatment of the most common forms of secondary hypertension","volume":"27","author":"Rossi","year":"2020","journal-title":"High Blood Press Cardiovasc Prev"},{"key":"R4-20260819","doi-asserted-by":"crossref","first-page":"802","DOI":"10.2215\/CJN.09180817","article-title":"Chronic kidney disease in India: A clarion call for change","volume":"13","author":"Varughese","year":"2018","journal-title":"Clin J Am Soc Nephrol"},{"key":"R5-20260819","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1038\/bonekey.2013.232","article-title":"Vitamin D and chronic kidney disease-mineral bone disease (CKD-MBD)","volume":"3","author":"Nigwekar","year":"2014","journal-title":"Bonekey Rep"},{"key":"R6-20260819","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1007\/s40620-016-0352-z","article-title":"Nonsteroidal anti-inflammatory drug use in patients with chronic kidney disease","volume":"30","author":"Heleniak","year":"2017","journal-title":"J Nephrol"},{"key":"R7-20260819","doi-asserted-by":"crossref","first-page":"3009","DOI":"10.3390\/nu14153009","article-title":"Vitamin D and secondary hyperparathyroidism in chronic kidney disease: A critical appraisal of the past, present, and the future","volume":"14","author":"Brandenburg","year":"2022","journal-title":"Nutrients"}],"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_401_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T12:01:50Z","timestamp":1787140910000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_401_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":7,"journal-issue":{"issue":"Suppl 1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aam.aam_401_25","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]},"assertion":[{"value":"2025-08-07","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-29","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}