Hipertension renovascular pediatrica
Transcript of Hipertension renovascular pediatrica
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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
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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
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