Late evaluation of the relationship between morphological and functional renal changes and hypertension after non-operative treatment of high-grade renal injuries

Abstract

ObjectiveTo evaluate the anatomical and functional renal alterations and the association with post-traumatic arterial hypertension.MethodsThe studied population included patients who sustained high grades renal injury (grades III to V) successfully non-operative management after staging by computed tomography over a 16-year period. Beyond the review of medical records, these patients were invited to the following protocol: clinical and laboratory evaluation, abdominal computed tomography, magnetic resonance angiography, DMSA renal scintigraphy, and ambulatory blood pressure monitoring. The hypertensive patients also were submitted to dynamic renal scintigraphy (99mTc EC), using captopril stimulation to verify renal vascular etiology.ResultsOf the 31 patients, there were thirteen grade III, sixteen grade IV (nine lacerations, and seven vascular lesions), and two grade V injuries. All the patients were asymptomatic and an average follow up post-injury of 6.4 years. None had abnormal BUN or seric creatinine. The percentage of renal volume reduction correlates with the severity as defined by OIS. There was no evidence of renal artery stenosis in Magnetic Resonance angiography (MRA). DMSA scanning demonstrated a decline in percentage of total renal function corresponding to injury severity (42.2 ± 5.5% for grade III, 35.3 ± 12.8% for grade IV, 13.5 ± 19.1 for grade V). Six patients (19.4%) had severe compromised function (< 30%). There was statistically significant difference in the decrease in renal function between parenchymal and vascular causes for grade IV injuries (p < 0.001). The 24-hour ambulatory blood pressure monitoring detected nine patients (29%) with post-traumatic hypertension. All the patients were male, mean 35.6 years, 77.8 % had a familial history of arterial hypertension, 66.7% had grade III renal injury, and average post-injury time was 7.8 years. Seven patients had negative captopril renography.ConclusionsLate results of renal function after conservative treatment of high grades renal injuries are favorable, except for patients with grades IV with vascular injuries and grade V renal injuries. Moreover, arterial hypertension does not correlate with the grade of renal injury or reduction of renal function.

Anti-hypertensive Herbs and their Mechanisms of Action: Part I

“…Hypertension is defined as having a systolic blood pressure (SBP) of ≥140 mmHg and a diastolic blood pressure (DBP) of ≥90 mmHg (≥140/≥90 mmHg; Tabassum and Ahmad, 2011 ). Every 20/10 (SBP/DBP) mmHg increase indicates a higher risk stage of hypertension; stage 1 (140–159/90–99 mmHg), stage 2 (≥160/≥100 mmHg; Archer, 2000 ; Weber et al, 2014 ) with the latter stage requiring immediate medical attention (Weber et al, 2014 ). Importantly, the American Society of Hypertension and ISH recommend that individuals with blood pressure of 120–139/80–89 mmHg be considered as pre-hypertensives (Weber et al, 2014 ).…”

“…Importantly, the American Society of Hypertension and ISH recommend that individuals with blood pressure of 120–139/80–89 mmHg be considered as pre-hypertensives (Weber et al, 2014 ). For targeted therapeutic interest, it is essential to realize that pre-hypertensive individuals are three times more likely to succumb to hypertension at a later stage of life than their normotensive counterparts (Archer, 2000 ). It is important to note that according to the Eighth Joint National Committee, it is recommended that for the general population, pharmacologic treatment be started at an SBP of 150 mmHg or DBP of 90 mmHg.…”

“…Many drugs, ranging from diuretics (Indapamide, Furosemide, Amiloride), sympathoplegic agents (clonidine, reserpine), renin inhibitor (Aliskiren), angiotensin converting enzymes (ACE) inhibitors (Enalapril, Captopril, Quinapril), angiotensin receptors blockers (ARBs—Losartan, Irbesartan, Olmesartan), calcium channel blockers (Nifedipine, Verapamil, Diltiazem), α-adrenergic blockers (Prazosin, Doxazosin), β-adrenergic blockers (Nebivolol, Atenolol) to vasodilators (Minoxidil, sodium nitroprusside), are used to manage blood pressure levels in hypertensive patients (Archer, 2000 ; Susalit et al, 2011 ). However, a point of interest to physicians and health-care practitioners is the alarming, and rather unfortunate, reality that high blood pressure is managed in only 34% of hypertensive patients (August, 2004 ; Wang and Xiong, 2012 ).…”

Safety and efficacy of Endovascular Management of high-grade blunt renal injury

“…Renal failure was not only associated with contrast medium injection but also with interventional procedures. 12 , 13 This study showed no significant differences in the level of creatinine or blood urea nitrogen estimated in patients before and after RAE. Renal failure was found in 1 patient with contralateral kidney hydronephrosis and in 1 patient with abnormal renal function before the intervention.…”

The incidence of long-term hypertension in children after high-grade renal trauma

“…The presence of preexisting hypertension in adult renal trauma patients is a potential confounder, making it difficult to accurately identify patients with hypertension directly related to the traumatic event. In one study where 9 of 31 patients experienced post-trauma hypertension 80% had a positive family history of arterial hypertension [10]. In contrast, pediatric populations generally do not have pre-existing hypertension, which allows for a potentially more accurate depiction of the association between renal trauma and hypertension.…”