Secondary PHA is limited to the kidneys and can develop due to drugs (cyclooxygenase inhibitors, angiotensinconverting enzyme inhibitors, potassium-sparing diuretics, trimethoprim, cyclosporine, etc.), congenital renal malformations, obstructive uropathy, VUR, UTI, tubulointerstitial nephritis, nephropathy in sickle cell anemia, renal amyloidosis, and  in multiple myeloma due to aldosterone insensitivity at the distal renal tubule (4). Here, ACE is linked to Pelger-Huet anomaly.