Introduction: Kidney malformations may associate secondary arterial hypertension, diagnosed at any age.

Objective: Presentation of a clinical case of dual re-nal malformation (renal polycystic disease developed on intrathoracic renal ectopia) and secondary arterial hypertension, in elderly age.

Methods: A 60-year-old adult patient diagnosed clini-cally, radiologically and by CT-scan with a rare renal congenital malformation, such as intrathoracic right kidney ectopia, without initial cardiovascular patho-logy. After years of evolution, increased blood pressu-res were found and so, the resumption of investigations detected the development of bilateral renal cysts, onto the ectopic background, with the appearance of renal polycystic disease, involving secondary hypertension.

Results: Secondary hypertension in adult is diagno-sed in renal polycystic disease malformation with la-tent evolution. Intrathoracic high renal ectopia was not initially associated with increased blood pressure, but polycystic development on this ectopic malformation led to its onset. The particularity of the case consists in the presence of two renal malformations, a very rare one, unilateral high intrathoracic ectopia and autosomal genetic di-sease, bilateral renal polycystosis associating secondary hypertension, with preserved renal function but with possibility of reduction by triple aggression: high ecto-pic congenital malformation, polycystic genetic disease and hypertensive nephropathy.

Conclusions: 1. Secondary arterial hypertension may be associated with renal malformations, both congeni-tal (renal intrathoracic ectopia), as well as genetic (re-nal polycystic disease). 2. Imaging plays an important role in diagnosis of both diseases and also in assessing cardiovascular and renal consequences. 3. Monitoring of antihypertensive therapy and evolution is required. Arterial hypertension in adult, often considered pri-mary, requires complex renal investigation for both se-condary etiology and complications.