Hypertension in children after renal transplantation

Bulum, Burcu; Özçakar, Z. Bı̇rsı̇n; Kavaz, Aslı; Tutar, Ercan; Ekı̇m, Mesı̇ha; Yalçınkaya, Fatoş

doi:10.1111/ped.12703

Cited by 4 publications

(4 citation statements)

References 37 publications

(78 reference statements)

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“…Elevated BP is one of the most common and serious complications following renal transplantation (30). In addition, epidemiological evidence suggests that the development of hypertension is an essential risk factor for morbidity and mortality following renal transplantation, and is also a prominent predictor for impaired graft survival independent of rejection episodes and transplant functions (5).…”

Section: Discussionmentioning

confidence: 99%

Renal transplantation increases angiotensin II receptor-mediated vascular contractility associated with changes of epigenetic mechanisms

et al. 2018

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Hypertension is one of the most common complications following renal transplantation, and it increases the risk of graft loss and other cardiovascular diseases. Previous studies have revealed that the use of angiotensin II (Ang II) blockers for preventing and treating hypertension is closely associated with higher survival following renal transplantation. However, the cellular and molecular mechanisms by which the vascular contractility of the recipient is altered in response to Ang II following renal transplantation have not been fully elucidated. In the present study, using the Fisher‑Lewis rat kidney transplantation model, the blood pressure (BP) of the conscious transplant recipient was measured following the intravenous administration of Ang II. In addition, the mechanisms underlying the Ang II-mediated vascular contractility via the type 1 and type 2 Ang II receptors (AT1R and AT2R, respectively) in large and small-resistance blood vessels were determined in the recipient after renal transplantation. The results showed that renal transplantation significantly increased the Ang II-stimulated BP of the rats. Additionally, ex vivo contractility experiments using aorta and mesenteric arteries revealed that the contractions induced by Ang II were significantly strengthened in the recipient following renal transplantation, and were associated with an increased intracellular Ca2+ concentration. Losartan almost eradicated the Ang II-induced contractions whereas PD-123319 had no apparent effects on the Ang II-induced contractions in the aorta and mesenteric arteries of the recipient. Furthermore, the expression levels of AT1R but not AT2R were significantly increased in the vasculature of the recipient following renal transplantation, which exhibited a close association with selective DNA demethylation detected in the promoter region of the vascular AT1aR gene. These results indicate that changes of recipient vascular AT1R gene expression, occurring through a mechanism involving DNA methylation, increase the vascular contractility in response to Ang II. This may lead to the increased risk of hypertension following renal transplantation.

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Section: Discussionmentioning

confidence: 99%

Renal transplantation increases angiotensin II receptor-mediated vascular contractility associated with changes of epigenetic mechanisms

et al. 2018

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“…Several studies on ABPM and INH in pediatric kidney transplant recipients have been published which showed that INH is present in an average 33% of children after KTx. [34][35][36][37] In one of the first studies on ambulatory hypertension in pediatric kidney transplant recipients, Matteucci et al showed that INH is present in 29% of their patients. 38 39 In a retrospective study done in our single center, we demonstrated a prevalence of 36% for INH and again no isolated daytime hypertension.…”

Section: Pre Valen Ce Of Inhmentioning

confidence: 99%

“…Similar to adults, the prevalence of INH is even higher in children after KTx than in CKD‐non KTx children. Several studies on ABPM and INH in pediatric kidney transplant recipients have been published which showed that INH is present in an average 33% of children after KTx 34–37 …”

Section: Prevalence Of Inhmentioning

confidence: 99%

Isolated nocturnal hypertension in pediatric kidney transplant recipients

Seeman

Pfaff

Sethna

2021

Pediatric Transplantation

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Background Isolated nocturnal hypertension (INH) is defined as nighttime hypertension in the setting of normal daytime blood pressure (BP), diagnosed by ambulatory BP monitoring (ABPM). Methods and Results Hypertension affects 60%–80% of pediatric kidney transplant recipients, and INH is the most common type of ambulatory hypertension. INH is associated with an increased prevalence of hypertension‐mediated target organ damage such as left ventricular hypertrophy in adults and in pediatric kidney transplant recipients. Conclusion Ambulatory BP monitoring should be performed annually in all pediatric kidney transplant recipients to diagnose hypertension phenotypes that are not detectable by office BP such as masked hypertension, white‐coat hypertension, or INH. Isolated nocturnal hypertension in pediatric transplant patients requires study as a treatment target.

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“…In treated hypertensive pediatric kidney transplant recipients, we and others have observed that readings taken in the clinical setting are not a solid surrogate for ABPM in identifying true responders to antihypertensive therapy. The point estimate prevalence of uncontrolled hypertension defined upon ABPM criteria in 457 treated hypertensive recipients was 54% (95% confidential interval 49–58%) [ 54 – 56 , 67 – 75 ]. Here, we would like to indicate that the term undertreated hypertension should be used instead of uncontrolled hypertension since in our experience, as we discuss later, the routine use of ABPM has resulted in a high prevalence of blood pressure control, whereas resistant hypertension is a rather uncommon condition [ 76 ].…”

Section: Blood Pressure Measurement In the Clinical Setting And Outsimentioning

confidence: 99%

Clinical value of ambulatory blood pressure in pediatric patients after renal transplantation

Krmar

Ferraris

2017

Pediatr Nephrol

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Hypertension is a highly prevalent co-morbidity in pediatric kidney transplant recipients. Undertreated hypertension is associated with cardiovascular complications and negatively impacts renal graft survival. Thus, the accurate measurement of blood pressure is of the utmost importance for the correct diagnosis and subsequent management of post-renal transplant hypertension. Data derived from the general population, and to a lesser extent from the pediatric population, indicates that ambulatory blood pressure monitoring (ABPM) is superior to blood pressure measurements taken in the clinical setting for the evaluation of true mean blood pressure, identification of patients requiring antihypertensive treatment, and in the prediction of cardiovascular outcome. This Educational Review will discuss the clinical value of ABPM in the identification of individual blood pressure phenotypes, i.e., normotension, new-onset hypertension, white-coat hypertension, masked hypertension, controlled blood pressure, and undertreated/uncontrolled hypertension in pediatric kidney transplant recipients. Finally, we examine the utility of performing repeated ABPM for treatment monitoring of post-renal transplant hypertension and on surrogate markers related to relevant clinical cardiovascular outcomes. Taken together, our review highlights the clinical value of the routine use of ABPM as a tool for identifying and monitoring hypertension in pediatric kidney transplant recipients.

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Hypertension in children after renal transplantation

Cited by 4 publications

References 37 publications

Renal transplantation increases angiotensin II receptor-mediated vascular contractility associated with changes of epigenetic mechanisms

Renal transplantation increases angiotensin II receptor-mediated vascular contractility associated with changes of epigenetic mechanisms

Isolated nocturnal hypertension in pediatric kidney transplant recipients

Clinical value of ambulatory blood pressure in pediatric patients after renal transplantation

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