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

The results of medical management of primary vesicoureteric refluc in 138 children aged 3 months to 15 years are presented. All children were kept on long-term, low-dose continuous chemoprophylaxis of urinary tract infection. During the 2-6 years follow-up period serial urine cultures, interval radiographic revaluation, renal function tests and blood pressure measurements were performed. Refluc disappeared spontaneously in 91 patients (66%), persisted in 9.4% and was later on surgically corrected in 20% of children. The refluc grade at presentation was the most important factor affecting the outcome: the refluc disappeared from 72% of affected ureters with grade I and II, and from 28% of ureters with grade III and IV. The presence of renal scaring and recurrence of urinary tract infection during the chemophylaxis did not influence the percentage of cured patients. Nevertheless, the mean duration of refluc from diagnosis to its spontaneous resolution was significantly longer in children with renal scars and urinary tract infections compared with its duration in children who had neither scars, nor further infections. Renal scarring progressed in 2.8% patients. Chronic renal failure developed, in spite of spontaneous resolution of refluc, in only one child with hypertension and bilateral renal scars at presentation. It is concluded that medical treatment of vesicoureteric refluc in most of the children is successful and in regard of preserving renal function stage.
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PMID:[Drug therapy of vesico-ureteral reflux in children]. 179 74

196 cases with vesicoureteral reflux (VUR) from multiple centers were analysed to examine the relationship between VUR and reflux nephropathy. The high correlation (p less than 0.01) was observed between reflux and renal scarring. Even in cases in whom VUR was not demonstrated at the time of testing, renal scarring of various degrees was recognized, suggesting either co-existed hypoplastic kidney or pre-existed infection. The renal scarring, but not VUR, had a significant correlation with proteinuria and hypertension. Retrospective analysis shows that the surgical treatment was closely related to the degree of renal scarring but not to the degree of reflux. Renal scarring progressed even when reflux did not become worse, which is probably accounted for by the presence of pyelonephritis. Although frequency of pyelonephritis decreased significantly (p less than 0.01) from 0.60 +/- 0.89 to 0.084 +/- 0.305 times/patient. year after anti-reflux surgery, renal scarring progressed in 13 kidneys (5.8%). Seven of the 13 kidneys became worse due to the surgical failure. The scar progression was recognized in the remaining six kidneys (three patients) including adult cases despite the successful surgical correction of reflux. Our study points to the urged need for a prospective clinical trial designed for the study of the pathological and clinical background of progressive renal failure in VUR.
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PMID:[Vesicoureteral reflux and renal scarring. Report of cooperative study of "Progressive renal disease" of Ministry of Health and Welfare]. 187 71

Renal injury associated with the intrarenal reflux (IRR) of urine that is either infected, under high pressure, or both, is a major cause of severe hypertension during childhood and adolescence and of chronic renal insufficiency in patients less than 30 years of age. Many, but not all, adolescent and adult patients with reflux nephropathy (RN) give a history of urinary tract infection (UTI) or unexplained fevers in infancy or early childhood, when the kidney is thought to be at greatest risk of injury. Although vesicoureteric reflux (VUR) is observed more commonly in infants than children with UTI, it is rare in uninfected patients at any age and should never be considered a normal finding during human development. Renal scarring may not be obvious in radiographic or radionuclear studies to medical management alone, no definite benefit of one over the other was observed, regardless of the grade of VUR. Moreover, progressive renal injury in scarred kidneys has been noted even after VUR had been corrected, when infection had been prevented, and while hypertension had been controlled satisfactorily. Focal glomerular sclerosis, a lesion found in patients with proteinuria and RN, has been identified not only in scarred kidneys, but also may be seen in contralateral, unscarred kidneys without VUR, which might suggest a humoral factor or, perhaps, a hyperfiltration phenomenon. RN is one of the most frequent causes of end-stage renal disease (ESRD) in children, adolescents, and young adults, which is potentially preventable. However, prevention will depend on early identification of patients at risk--infants and young children after the first UTI and siblings of patients with VUR--aggressive and effective treatment of UTI, minimizing intravesical pressure, and education of patients, parents, and physicians.
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PMID:Vesicoureteric reflux and renal injury. 202 50

Although much remains to be learned, most pediatric nephrologists and urologists are now in comfortable agreement with the following assumptions: (1) Most reflux (primary reflux) is due to a congenital anatomic abnormality of the bladder trigone. (2) In many instances this anomaly improves with growth and development of the child so that the reflux may cease spontaneously. In low-grade (I-II) reflux with undilated ureters, approximately 75 to 85 per cent will stop refluxing. In higher grades (III-V) with dilated ureters, the cessation rate is in the range of only 25-30 per cent. (3) Although radiologic grading is helpful in predicting the likelihood of spontaneous cessation, it is possible to improve that predictability by cystoscopic evaluation of the size, configuration, and position of the ureteral orifice plus the length of the submucosal tunnel. (4) Reflux in combination with bacteriuria can and does lead to renal scarring. (5) Renal scarring probably does not occur in patients with primary reflux and normal voiding pressures in the absence of bacteriuria. (6) Renal growth may proceed normally despite sterile reflux. (7) A few refluxing patients, perhaps 10 per cent, will have bacteriuria despite continuous antimicrobials, and these "breakthrough" infections may cause renal scars. (8) Other patients prove either unwilling or unable to comply with continuous medications and are also vulnerable to scars. (9) A successful antireflux operation may not change the recurrence rate of urinary tract infections per se, but it almost eliminates the likelihood of pyelonephritic episodes and the necessity for further continuous antibiotics. Unfortunately, in patients with intermediate grades of reflux, it is not presently known whether an early surgical correction might be more effective in allowing normal renal growth, in avoiding renal scars, and in preventing eventual hypertension, which is present as a late complication in almost 20 per cent of the patients. The data to answer this important question should ultimately be forthcoming from the current International Collaborative Reflux Study.
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PMID:Reflux uropathy. 330 52

The long-term results after antireflux operation in 47 adults are presented. Reflux was eliminated in all but 3 cases. Preoperatively most patients complained of urinary tract infection with or without fever, but sometimes investigation for hypertension or urolithiasis also led to the diagnosis. Postoperatively 70% of the patients are free of symptoms and infection. Renal scarring in pyelonephritic patients seems to stop after intervention. In all patients with a normal preoperative creatinine level, this level stays normal after the intervention. However, in 6 of 7 patients with a creatinine level of greater than 1.5 mg% before operation, the intervention could not stop the evolution toward terminal renal failure.
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PMID:Antireflux in adults: a long-term follow-up. 381 93

Despite normal to suppressed levels of renin activity in chronic renal disease, multiple lines of evidence suggest a role for the RAS, especially its intrarenal expression, in several critical aspects of this condition. Alterations in the distribution and control of components of the renal RAS could account for localized areas of activation of this system. Renal scarring may be particularly important as a major stimulus to renin synthesis in the diseased kidney. While both intrarenal and systemic hypertension may depend in part upon actions of the RAS, other non-hemodynamic actions of the RAS may also contribute to the adaptation of residual nephrons as well as their progressive injury.
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PMID:The paradox of the renin-angiotensin system in chronic renal disease. 816 26

Scintigraphic evaluation of urinary tract infection, pyelonephritis, and renal scarring represents a significant portion of a clinical pediatric nuclear medicine practice. Renal scarring from recurring infection remains an important cause of end-stage renal disease and hypertension in the pediatric population. However, the clinical presentation in infants and young children is often elusive, and clinical diagnosis of upper tract involvement is frequently unreliable. As a result, diagnostic imaging has a critical role to play in the localization of infection to the lower or upper urinary tract. Radionuclide cystography and renal cortical imaging have become mainstays of this evaluation. Direct radionuclide cystography is the preferred cystographic screening technique, because it has lower radiation exposure and greater sensitivity for the detection of vesicoureteral reflux than either indirect radionuclide cystography or fluoroscopic contrast cystography. Renal cortical scintigraphy has become the standard for the detection of pyelonephritis and renal scarring. Correlation with histopathology has demonstrated a high degree of diagnostic accuracy. Acute pyelonephritis has been shown to be the necessary etiologic factor for the development of subsequent renal scarring, and the mechanism of renal injury in pyelonephritis has been extensively studied in experimental models. The ability of prompt and appropriate antibiotic therapy to dramatically reduce the incidence of subsequent scarring also has been conclusively demonstrated both clinically and in the experimental model. Vesicoureteral reflux was once thought to be a necessary prerequisite for the development of renal scarring. Although it is clear that the intrarenal reflux of infected urine will create pyelonephritis in the experimental model, the high incidence of pyelonephritis and subsequent scarring in the absence of demonstrable vesicoureteral reflux leaves the role of reflux in question. Although the role of vesicoureteral reflux is incompletely understood, its detection nevertheless remains a standard part of the patient's evaluation.
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PMID:Scintigraphic evaluation of pediatric urinary tract infection. 837 94

This study was undertaken to determine the prevalence of hypertension in children with primary, uncomplicated vesicoureteral reflux (VUR) and to evaluate the relationship between blood pressure (BP), grade and duration of reflux, and renal scarring. Subjects were identified retrospectively during a 17-year period; of 146 subjects who agreed to participate, 129 (88.4%) were female. Mean age at diagnosis was 5.0 years (range, 1 month to 16 years), and at follow-up was 14.4 years (range, 5 months to 21 years). Mean duration of follow-up was 9.6 years. Renal scarring was detected in 34.3% of patients by intravenous pyelogram, ultrasonography, or both. The BP at diagnosis was linearly related to the grade of reflux, but values were not higher than expected norms for age. At follow-up, mean systolic and diastolic BP were at the 41.6 percentile and the 18.7 percentile, respectively. No patient's BP was above the 55th percentile. After a mean follow-up period of 10 years, we conclude that primary, uncomplicated VUR, regardless of the number of documented urinary tract infections, duration and severity of reflux, modality of therapy, presence of renal scarring, and duration of follow-up, is not associated with the development of hypertension. Hypertension does not appear to be a complication of VUR and urinary tract infection unless there is preexisting dysplasia.
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PMID:Prevalence of hypertension in children with primary vesicoureteral reflux. 841 May 7

Renal scarring is the main long term complication of acute pyelonephritis in children. The prevalence rate is hazardous since data from the literature are confusing with respect to reflux nephropathy, chronic pyelonephritis and renal hypoplasia. The pathology of such lesions consists in focal interstitial fibrosis. When the first pyelonephritic attack occurs during infancy, renal growth may be compromised. The current approach of renal scar assessment is based on dimercaptosuccinic acid (DMSA) scan. Bilateral extensive lesions may be responsible for altered glomerular filtration rate (GFR) and/or arterial hypertension. The management of overt scarring is conservative and careful prevention must be based on early and aggressive treatment of acute pyelonephritis.
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PMID:[Parenchymatous cicatrix and urinary tract infection: physiopathology and clinical implications]. 975 21

Renal scarring associated with vesico-ureteric reflux (VUR), most commonly detected in young children, is associated with a significant risk of developing hypertension in later life. Hypertension in reflux nephropathy contributes significantly to morbidity including deterioration of renal function. The mechanism of onset of hypertension is not clear although abnormalities of the renin-angiotensin system and sodium/potassium ATPase activity have been described in some cases. It is becoming clear that radiologically detectable renal scars or small kidneys may histologically indicate a variety of diagnoses. Prediction of the risk of developing hypertension in individual cases is difficult and therefore regular follow-up remains the only current means of recognising these subjects. Although prevention of renal scar development in children with VUR may offer some benefit in reducing the incidence of hypertension, there is no uniform action that can definitely achieve this, particularly in the very young, before any urinary infection occurs. Primary VUR seems to be a disorder with mendelian dominant inheritance and location of the gene may offer some hope of early identification within certain families. Timely introduction of preventative measures may then be possible even though reservations exist about their effectiveness.
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PMID:Reflux nephropathy and hypertension. 975 82


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