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

Severe renin-mediated hypertension was noted in 2 children as a result of selective renal damage from vesicoureteral reflux during the early years of life. In each case the reflux had been corrected successfully long before hypertension developed. In 1 case the late damage involved only 1 kidney and nephrectomy resulted in immediate relief of the hypertension. In the second case, even though both kidneys showed segmental scarring from calicectasis and chronic pyelonephritis, removal of the atrophied lower pole of 1 kidney made hypertension amenable to medical treatment and reduced excessive renin output to a fraction of the original high levels. The mechanism of renin-mediated hypertension in kidneys with segmental scars of chronic pyelonephritis is believed to be ischemia of the relatively normal renal cortex in proximity to areas of interstitial fibrosis, within which are tortuous interlobular and smaller arterioles with severe intimal thickening. Hypertrophy of normal renal segment occurs in young patients with segmental chronic pyelonephritis. To accommodate this enlargement the original calix develops an extension or elongation readily distinguishable from other dilated calices.
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PMID:Malignant hypertension in children secondary to chronic pyelonephritis: laboratory and radiologic indications for partial or total nephrectomy. 61 6

We are reporting on a decade of experinece with cases of renal tuberculosis treated at a large tuberculosis hospital. Most patients were men less than 50 years old. The most frequent symptoms were dysuria, back or flank pain, nocturia and hematuria. Physical examinations were generally normal and hypertension was not seen. Most patients had acid urinary pH, pyuria and/or hematuria. Excretory urograms were abnormal in 86 per cent of the cases, the most common finding being preserved function but calicectasis or abscess. Most patients had abnormal chest x-rays and nearly half of them had coexisting, active pulmonary or miliary tuberculosis. Tuberculin tests were positive in 85 per cent of the cases. In our experience urinary tuberculosis was almost always responsive to multi-drug chemotherapy, even in patients with a non-functioning, tuberculous kidney. An asymptomatic, non-functioning kidney need not be removed, provided documentation of urine culture conversion is obtained and a prolonged period of multi-drug chemotherapy is completed.
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PMID:Urinary tuberculosis: a review of 44 cases treated since 1963. 127 40

During a ten-year period, 35 children presenting with vesicoureteral reflux, ureteropelvic junction obstruction, or a "small kidney" were found to be hypertensive. Of these, 15 subsequently underwent surgical procedures for relief of hypertension. Seven were "cured," six were "improved," and two were "unchanged." The severity of hypertension could not be correlated with the degree of reflux nor with the degree of obstructive uropathy. However, all children with reflux in our study who were hypertensive had some degree of calicectasis noted preoperatively on intravenous pyelogram. Also it was noted that hypertension may occur several years after successful anti-reflux surgery. Children with vesicoureteral reflux, ureteropelvic junction obstruction, or a small kidney need to have blood pressure determinations at regular intervals, even if all previous readings had been in the normotensive range and whether or not they were followed up medically or post surgically. We suggest that blood pressure determinations be made every three months for the first year after diagnosis of reflux or ureteropelvic junction obstruction, and at least once a year thereafter.
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PMID:Management of children with hypertension from reflux or obstructive nephropathy. 304