Hipertensão Renovascular: Casuística de uma Consulta de Nefrologia Pediátrica

Abstract

Introduction: Hypertension in children is usually secondary and potentially treatable; 3%-10% of this population have renovascular hypertension. The authors aimed to assess the clinical features, treatment and outcome of a group of children with this diagnosis. Methods: We performed a retrospective descriptive study of renovascular hypertension cases seen in paediatric nephrology consultations in a level III hospital between January 2006 and June 2016. Results: Nine patients were included (six male, mean age at diagnosis of renovascular hypertension 6.7 ± 2 years). The diagnosis of hypertension was made in the context of headache in one patient, slow weight gain in another, and routine assessment in the other seven, who were asymptomatic. Systemic disease was identified in two patients (type I neurofibromatosis and Takayasu arteritis). Renal Doppler ultrasound identified renal artery stenosis in 88.9% of cases and angiography in 100% of the eight performed (unilateral in seven).In two patients hypertension was pharmacologically controlled. Due to persistence of hypertension in the other seven (three with severe hypertension despite taking four drugs), revascularisation procedures were performed: angioplasty in five and artery reimplantation in two. During clinical evolution, three underwent stent implantation and three had renal artery thrombosis and nephrectomy. At the last assessment (mean follow-up of 2.8 years), three patients were not taking antihypertensive treatment. Discussion: We emphasise the importance of systematic measurement of blood pressure in children, since even severe hypertension may be asymptomatic. Renovascular hypertension often requires various invasive therapeutic procedures that are not without risk. Aetiological investigation and early intervention can slow the progression of renal disease and modify the prognosis.Keywords: Child; Hypertension; Hypertension, Renovascular Introdução: A hipertensão arterial em idade pediátrica é geralmente secundária e potencialmente tratável, sendo que 3%-10% desta população tem hipertensão renovascular. Este trabalho teve como objetivo avaliar as manifestações clínicas, tratamento e evolução dos doentes com este diagnóstico. Métodos: Estudo retrospetivo descritivo dos casos de hipertensão renovascular admitidos na consulta de nefrologia pediátrica de um hospital de nível III, de janeiro de 2006 a junho de 2016. Resultados: Incluíram-se nove doentes (seis do género masculino, idade média no diagnóstico 6,7 ± 2 anos). O diagnóstico de hipertensão arterial foi feito em contexto de cefaleias num doente, má progressão ponderal noutro, e nos sete restantes que estavam assintomáticos, em avaliação de rotina. Dois tinham patologia sistémica (neurofibromatose tipo I e arterite de Takayasu). A ecografia renal com Doppler identificou estenose da artéria renal em 88,9% dos casos e a angiografia em 100% dos oito casos em que foi realizada (estenose bilateral num doente). Em dois doentes a hipertensão arterial foi controlada farmacologicamente. Nos outros se...