Hipertension renovascular pediatrica

download Hipertension renovascular pediatrica

of 3

Transcript of Hipertension renovascular pediatrica

  • 8/10/2019 Hipertension renovascular pediatrica

    1/3

    IPNA 2

    THE EDITORS

    N Gallego

    L Orte

    A Belanger

    Aracil

    J Ortuno

    iatric renovascular hypertension

    Renovascular hypertension

    Percutaneous

    have read with great interest the article Evaluation

    of pediatric renovascular hyper-

    in theSeptember 2000 issueof

    Pedi-

    ephrology [1].Inthe last 22 years we have treated

    5 daysto 15years with renovascular

    inthe char-

    of our

    patients

    and the

    utility

    of

    some diag-

    and

    therapeutic techniques.

    In our

    series neurofi-

    for

    only 15%

    of

    cases

    and in

    to 70%of our children hypertension was a casual

    ata routine physical examination.

    We performed Doppler ultrasonography and basal

    in11ofour patients and

    to the angiographic findingsin 9

    In contrast, isolated basal

    is not useful becauseif it yields normalre-

    it does notexclude theexistence of renal artery

    a pathological result canbeduetothe ex-

    of parenchymatous lesions [2]. Doppler ultraso-

    is

    useful

    in

    expert hands, either

    as a

    screen-

    or to evaluate the resultsof treatment [3];it

    inchildren, who have less ab-

    andadipose tissue than adults. Thera-

    ofthe4patientsinwhich spiral com -

    was performed were

    N. Gallego

    L. Orte

    A. Belanger

    J.Ortuiio

    ofNephrology. Hospital RamonyCajal,

    of Vascular Surgery, Hospital RamonyCajal,

    )

    very similar to thoseof angiography. We believe

    technique will have

    a

    great future because

    it is

    invasive and less time consuming than conventi

    angiography.

    We have performed percutaneous translum

    angioplasty (PTA) 10times in 8children; 7 of t

    are cured, although 1required a second PTA beca

    of re-stenosis.

    The

    other patient

    was an 8-kg,

    month-old child with bilateral stenosis,

    and

    altho

    he is notcured this treatment allowed a reduction

    the number of antihypertensive drugs. All these

    tients had fibromuscular dysplasia because,asstate

    the literature, PTA cannotbe performed over ostial

    sions,

    as in the middle aortic syndrome,and inNF

    sultsare variable, probably depending on thekind

    histological lesion [2, 4, 5, 6, 7]. In ourexperie

    these less-invasive diagnostic andtherapeutic meth

    used

    in

    adults are also useful

    in

    children, yielding g

    results.

    t.o

    800 0

    0 0

    0 0

    1 0

    2 0

    ks

    0 0

    1 0

    k

    Fig

    la b Basal andpost-captopril renography of a girl with

  • 8/10/2019 Hipertension renovascular pediatrica

    2/3

    SJ, Gelati S,Walker RG , Powell HR, JonesCL

    (2000) Evaluation and long-term outcome of pediatric renovas-

    cular hypertension. Pediatr Nephrol 14:1022-1029

    Guzzeta PC, Potter BM, Ruley EJ, Madj M, Bock GH (1989)

    Renovascular hypertension in children: current co nceptsin

    evaluation and treatment.

    J

    Pediatr Surg 24:123 6-124 0

    Garel L, Dubois J. Robitaille P. Russo P. Filiatrault D. Grignon

    A. Dube

    J

    (1995) Renovascular hypertension

    in

    children: cur-

    ability predicted with negative intrarenal Doppler US results.

    Radiology 195:401 405

    Chevalier RL. Tegtmeyer CJ. GomezA(1987) Percutaneou s

    transluminal angioplasty for renovascular hypertension in chil-

    dren. Pediatr Nephrol

    1:89-98

    5. Courtel JV, Soto

    B,

    Niaudet

    P.

    Gagnadoux MF, C arte

    Quignodon JF, Carteret M. Quignodon JF, Brunelle F

    Percutaneous transluminal angioplasty

    of

    renal artery st

    in children. Pediatr Radiol 28:59-61

    6. FossaliE.Signorini E.Intermite RC . Casalini E,Lova

    Maninetti MM. Rossi LN (2000) Renovascular disease an

    pertensionin children with neurofibromatosis. Pediatr N

    14:806-810

    7. Daniels SR. Loggie JMH McEnery PT, Towbin RB

    Clinical spectrum of intrinsic renovascular hypertension in

    dren. Pediatrics 80:698-704

    LITERATURE ABSTRACTS

    Wang H.F. Cheng S. Shappell R.C. Harris

    ie ctive cyc looxygen ase 2 inhibitor

    n al In jury in rats

    We have previously shown that cyclooxygenase-2

    islow in the renal cortex of adult r ats, butis

    inmacula densa/cortical thick ascending limb andin

    Toevaluate thefunctional consequ ences of thisin-

    tosubtotal

    theangiotensin-conv erting enzyme inhibitor

    Within one week after ablation, vehicle-treated rats devel-

    led tosignificant reduc-

    inblood pressu re, either aloneor incombination with the

    58236, 3O2 mg/day; n=l f< 0 .01 ,each group compared

    topersistent

    P

  • 8/10/2019 Hipertension renovascular pediatrica

    3/3