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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Preliminary results of this retrospective-prospective analysis of renal hypertension in 110 children indicate that hypertension may be secondary to a wide variety of acute progresive, and chronic renal diseases which may be either congenital or acquired. Affected children may be detected at any time from infancy through adolescence. Symptoms usually associated with acute glomerulonephritis (i.e., headache, swelling, nausea, vomiting, anorexia, fatigue, dizziness, and fever) occur in both acute and chronic renal diseases associated with hypertension. Headache and swelling are the most common symptoms in this series. Peripheral edema, rales, and increased heart size were found in between 10 and 25% of these children. Differential diagnosis may be approached by a consideration of causes of acute and chronic hypertension. The child with chronic renal disease usually presents with a long history of fatigability, poor growth, and pallor, and laboratory tests reveal elevation of the creatinine and BUN along with anemia, hypocalcemia, and hyperphosphatemia. In contrast, the child with acute renal disease and hypertension presents with a history of prior good health followed by the abrupt onset of signs and symptoms of renal disease; laboratory tests usually reveal modest elevations of creatinine and BUN, anemia is unusual, an abnormal urinalysis is common, and serum calcium and phosphorous levels are usually normal. Renovascular and asymmetric renal parenchymal disease represent uncommon but important conditions because surgery may be curative. Treatment may be surgical, medical, or combined. Surgical conditions include renal trauma, hydronephrosis, asymmetric renal disease, and renal arterial disease. Adequate blood pressure control without medication can be expected following surgery in instances of unilateral involvement with a normal contralateral kidney. Meticulous assessment of the contralateral kidney is needed to determine that it is normal. If surgery is unsuccessful or is not indicated, pharmacologic therapy is initiated with a stepwise regimen starting with the mildest agent (e.g., thiazides) and then adding additional antihypertensive drugs when adequate blood pressure control has not yet been achieved. The goal of therapy is the lowest, safest, tolerated blood pressure levels. Long-term, carefully designed studies of antihypertensive agents for children with renal hypertension are not available. The need for collection and critical analysis of data concerning the clinical course of children with renal hypertension is evident from a review of the literature and from the preliminary data presented in this series. The presentation of such information and a critique of outcome variables will provide a basis for program planning for affected children and improvement in patient care where indicated.
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PMID:Renal hypertension in children. 99 44

A significant number of offspring from brother-sister matings of NIH-Okamoto-Aoki spontaneously hypertensive rats (SHRs) were found to be normotensive at 20 weeks of age. Over 20% of the animals that were hypertensive at this age had mild-to-moderate unilateral hydronephrosis at the time of sacrifice. In over 90% of the rats that did not develop hypertension spontaneously, ligation of one ureter raised blood pressure above 150 mm Hg within 2 weeks. In those rats made hypertensive by obstructing one ureter and in those that developed hypertension with accompanying naturally occurring hydronephrosis, subcutaneous implants of fragmented renal medulla from unrelated normal rats decreased blood pressure to normotensive levels. In contrast, medullary implants had no significant effect in rats developing hypertension spontaneously without hydronephrosis. Renal inner medullary plasma flow was low in the obstructed kidneys of hydronephrotic hypertensive SHRs but was elevated in the kidneys of nonhydronephrotic hypertensive SHRs. The hypertension in hydronephrotic SHRs appears to be related to an impairment of the antihypertensive function of the renal medulla. Such an impairment of medullary antihypertensive function does not appear to play a significant role in the hypertension in SHRs without hydronephrosis.
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PMID:The renal medulla and mechanisms of hypertension in the spontaneously hypertensive rat. 99 30

The antihypertensive action of renomedullary autotransplantation was investigated in rats with unilateral hereditary hydronephrosis showing extensive destruction of the medulla of the affected kidney. All rats were divided into three groups and unilaterally nephrectomized. The first group consisted of rats with a normal kidney remaining. The second and third groups had the hydronephrotic kidney remaining and received renomedullary and renocortical autotransplants, respectively. After completion of baseline studies, all rats were given 1 per cent saline solution instead of drinking water, and relevant parameters were re-examined 14 days later. Significant increase in blood pressure (greater than 150 mm. Hg), extracellular fluid volume, and plasma volume were found in group 3 while no changes were detected in groups 1 and 2. After administration of aspirin (and presumed blockade of prostaglandin synthesis) significant increases in plasma and extracellular fluid volumes were detected in groups 1 and 2, but no change in blood pressure was found. The results show that renomedullary transplantation protects against salt-induced hypertension and further indicate that the renomedullary prostaglandins are not a likely mediator of the antihypertensive action of the renal medulla.
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PMID:Salt-induced hypertension in rats with hereditary hydronephrosis: the effect of renomedullary transplantation. 110 51

Three patients with unilateral hydronephrosis, a normal contralateral kidney, and sustained hypertension were investigated by means of arteriography and differential renal vein renin determinations. The close correlation of the onset of hypertension to the obstructive uropathy, as well as the increased renin production from the affected side, were indicative of a causal relationship. Nephrectomy produced a prompt cure of hypertension in each instance.
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PMID:Hypertension and unilateral hydronephrosis. 111 52

Twenty patients with hypoplastic kidney (12 men and 8 women, left kidney in 13 cases, right kidney in 7 cases) were observed between 1961 and 1971. The age of the patients ranged from 14 to 60 years. The anomaly predominated (65% of the patients) in the third and fourth decades of life; in this age the diagnosis of the true nature of the condition was often due to complications requiring examination. Carefully taken history and complete radiological survey are essential for the recognition. The value and characteristic features yielded by particular investigation are discussed. In 8 patients clincial diganosis was confirmed at operation. Most common complications of hypoplastic kidney included hypertension, lithiasis, hydronephrosis, pyelonephritis and periodic hematuria. In 9 pateints (4 women and 5 men) renal hypoplasia was associated with other anomalies of the genitourinary tract.
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PMID:Hypoplasia renum: a comparative study of diagnosis, clinical course and management. 115 Mar 89

It is apparent that the split function study and renal vein renin determination are complementary and afford valuable information for selecting patients with potentially curable renovascular hypertension. The split function study, when interpreted with the recently defined split function ratio, offers the clinician a highly accurate means of diagnosing significant renal ischemia. Because the split function ratio shows the disparity between the ischemic and contralateral kidney to a greater degree, the chance of misdiagnosis due to laboratory or physician error is minimized. The split function study, however, is of limited value in patients with pyelonephritis since the water- and salt-losing characteristics of the pyelonephritic kidney may mask significant renal ischemia. In these patients, as well as those with a nonfunctioning kidney or hydronephrosis, the renal vein renin determination is the test of choice. In addition, the added morbidity of the split function study is not warranted in a patient with an elevated peripheral renin which, for interpretation, requires an accurate 24 hour urine for sodium, a renal vein renin ratio outside the range of patients with essential hypertension (renal vein renin ratio greater than 1.7) and evidence of suppression of renin secretion from the contralateral kidney. If, however, the renin determination does not afford convincing evidence of significant renal ischemia in a patient with radiographic evidence of renal arterial stenosis, a split function ratio definitely should be determined to more completely define the pathology. The attendant morbidity of a carefully performed split renal function study does not approach the morbidity and mortality associated with unnecessary surgery or inadequately treated hypertension.
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PMID:Ureteral catheterization studies. 115 55

In a review of 156 total or partial nephrectomy specimens from patients over the age of 12 years, renal dysplasia was found 14 times. The cases were divided initially into five groups on the basis of the predominant pathological changes, namely (1) dysplasia (14 cases), (2) chronic pyelonephritis (31 cases), (3) calculous inflammation (58 cases), (4) hydronephrosis (35 cases), and (5) miscellaneous (18 cases). The diagnosis of dysplasia was made on gross and microscopic criteria and included 12 of segmental dysplasia, one of total dysplasia, and one multicystic dysplastic kidney. The principal differential diagnosis is from the irregularly scarred chronic pyelonephritic kidney. The criteria for the separation of the two are emphasized and, in particular, the distinction from those pyelonephritic kidneys with aglomerular scars. A high incidence of anomalies of drainage was found in association with dysplasia, but such were not always present. It was not thought that intrarenal reflux in infancy was an aetiological factor. Six of the cases presented with urinary infection, but only two had hypertension. It was thought that acquired glomerular damage was more important in the aetiology of hypertension than segmental glomerular agenesis.
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PMID:Renal dysplasia in nephrectomy specimens from adolescents and adults. 123 28

A fifty-seven-year-old patient with a five to one elevation of right renal vein plasma renin activity associated with a large, simple cortical cyst of the right lower pole is presented. Marsupialization of the cyst was associated with improvement in the patient's hypertension and the finding of bilaterally equal renal vein renin activity three months postoperatively. Possible mechanisms for hypertension are discussed in context of the experimental models of Goldblatt and Page in such lesions as cortical cysts of large size causing hydronephrosis, vascular stretching, or renal parenchymal compression.
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PMID:High renin hypertension associated with renal cortical cyst. 127 11

The rapid-sequence intravenous urogram (IVU) has tended to fall from favour for investigating hypertension because of its perceived imprecision for detecting renovascular disease. However, no study has examined the value of the IVU as a screening test in appropriately selected patients. We have analysed the diagnostic yield of the rapid-sequence IVU in hypertensive patients selected for features suggesting renal or renovascular disease in a retrospective review of case records from a hypertension clinic. The IVU was abnormal in 27% (95% CI 21-32%) of 241 consecutive patients. The most common abnormalities were chronic pyelonephritis (6%); proven renovascular disease (5%); stone (4%); possible renovascular disease and simple cyst (each 3%); hydronephrosis (2%); and tumour and active tuberculosis (each 1%). The IVU led to intervention aiming to correct hypertension in 5% (95% CI 2-8%) of patients, and revealed an abnormality needing intervention in its own right in 4% (95% CI 2-6%). The IVU led to unnecessary invasive investigation in 3% of cases. Individual abnormalities could not be predicted from the clinical or laboratory features. The initial investigation in hypertensive patients with suspected renal or renovascular disease should be a general purpose test able to detect a wide range of abnormalities. The rapid-sequence IVU is the only single test capable of satisfying this requirement. In patients with features suggesting renovascular disease, a normal rapid-sequence IVU excludes renovascular disease with 93% probability, but is an imperfect screening test since it fails to diagnose about 20% of cases. Renal arteriography should be done despite a normal IVU when it is essential to exclude renovascular disease.
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PMID:Investigation of selected patients with hypertension by the rapid-sequence intravenous urogram. 135 Dec 13

In a clinical follow-up, 47 patients after unilateral or partial nephrectomy were examined. The average age at operation was 5.8 years (range 3 days-17.1 years), the average follow-up period after surgery was 11.9 years (range 8.2-18.3 years). Main indications for surgery were hydronephrosis (n = 27), other congenital malformations (n = 6) and neoplasia (n = 9). In one patient, we found hypertension, two patients presented with moderately diminished creatinine clearance, two further patients suffered from unilateral hydronephrosis after partial nephrectomy. We found by ultrasonography marked compensatory hypertrophy in cases of solitary kidneys (225.6 +/- 49.3%) as well as contralateral kidneys after partial nephrectomy (158.7 +/- 55.6%).
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PMID:Long-term results after partial and unilateral nephrectomy in childhood. 142 70


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