Renal manifestations in toddlers with Takayasu’s arteritis and malignant hypertension

Hijazi, Rana; Chandar, Jayanthi; Nwobi, Obioma; Muneeruddin, Samina; Zilleruelo, Gastón; Abitbol, Carolyn

doi:10.1007/s00467-008-1088-3

Cited by 24 publications

(19 citation statements)

References 17 publications

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“…In our series, five of 22 (22.7%) patients with renovascular hypertension had mid-aortic syndrome; this prevalence rate of midaortic syndrome is within the previously reported range (20%-48%) (5,21). It has been suggested that renovascular hypertension patients with midaortic syndrome may be appropriate for surgical revascularization (19,22). This might be one explanation for the PTRA procedure failure in some patients in this study.…”

Section: Discussionsupporting

confidence: 79%

Angioplasty for pediatric renovascular hypertension: a 13-year experience

Zhu

He²,

Gu³

et al. 2014

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to evaluate the long-term outcome and efficacy of percutaneous transluminal renal angioplasty (PTRA) for pediatric renal artery stenosis (RAS), which is an important cause of medication-refractory pediatric hypertension. MATERIALS AND METHODSWe retrospectively evaluated 22 hypertensive children (age range, 3-17 years) who underwent PTRA from February 2000 to July 2012. Sixteen patients had Takayasu arteritis and six fibromuscular dysplasia. Five were not included in the statistical analysis due to loss to follow-up. RESULTSTechnical success was achieved in 32 of 34 procedures (94.1%). The stenosis rate decreased from 84.5% before PTRA to 20.1% after PTRA. Treatment was effective in 72.7% (16/22) of patients, including complete cure in 27.3% (6/22) and improvement in 45.5% (10/22). Systolic and diastolic blood pressures decreased from 153±19.1 to 131.7±21.4 mmHg and from 97.9±14.2 to 83.6±19.3 mmHg, respectively (P < 0.01). Number of antihypertensive agents decreased from 2.7 to 0.5 per patient. Restenosis was detected in 40.9% (9/22) of patients, with a restenotic interval of 11.8 months (range, 3-47 months). Lesion length was strongly correlated with clinical success (cure and improvement) (independent-sample t test, P < 0.001; binary logistic regression, P = 0.040). CONCLUSIONLesion length is an important determination of clinical success with PTRA for pediatric RAS. PTRA is an appropriate treatment option for pediatric renovascular hypertension due to Takayasu arteritis and fibromuscular dysplasia.

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Section: Discussionsupporting

confidence: 79%

Angioplasty for pediatric renovascular hypertension: a 13-year experience

Zhu

He²,

Gu³

et al. 2014

Diagn Interv Radiol

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“…Only a few clinical studies described the development of FSGS in malignant hypertension [12][13][14], and these studies reported that FSGS may occur in primary malignant hypertension with nephrotic-range proteinuria, and may contribute to renal dysfunction. In addition, a few cases of renal artery stenosis with malignant hypertension and nephrotic syndrome have been reported [15][16][17][18][19][20]. In such cases, histopathological examination of the contralateral kidney often shows lesions of FSGS with benign or malignant nephrosclerosis.…”

Section: Discussionmentioning

confidence: 99%

A case of secondary focal segmental glomerulosclerosis associated with malignant hypertension

et al. 2012

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Focal segmental glomerulosclerosis (FSGS) is associated with various clinicopathological conditions, including hypertension. We report here a case of secondary FSGS associated with malignant hypertension. A 33-yearold man with a 1-month history of visual impairment and headache visited the Department of Ophthalmology at our hospital and was found to have hypertensive retinopathy and severe hypertension (230/160 mmHg). He was referred to our department based on suspected renal dysfunction. His blood pressure on admission was 250/130 mmHg. Physical examination and laboratory tests revealed hypertensive cardiac dysfunction, focal brain edema, renal dysfunction (serum creatinine, Cr 7.07 mg/dl, blood urea nitrogen, BUN 49.9 mg/dl), massive proteinuria (10.7 g/day), and thrombotic microangiopathy. Funduscopy showed exudate, hemorrhage, and papilledema. The cause of secondary hypertension could not be identified. He was treated for primary malignant hypertension, but required hemodialysis 3 days after admission due to anuria. Treatment with antihypertensive agents resulted in the gradual recovery of renal function, although heavy proteinuria continued with nephrotic syndrome. Renal biopsy performed 1 month after admission showed features of malignant nephrosclerosis with secondary FSGS. Hemodialysis was discontinued following further improvement in renal function and the most recent laboratory tests showed proteinuria 1.8 g/day and persistent renal dysfunction (BUN 36.5 mg/dl, Cr 3.14 mg/ dl). Malignant hypertension may cause various injuries, including glomerular endothelial and epithelial cell injuries in glomerular hypertension and hyperfiltration, increase of the renin-angiotensin-aldosterone system, and endothelialepithelial interaction, resulting in the development of secondary FSGS and heavy proteinuria.

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“…Marks and Tullus for their interest in our report of 3 cases of young children with Takayasu's arteritis (TA) [1]. They raise a cogent point, that, neither European nor American rheumatology societies, include inflammation as a classification criterion for the diagnosis of this rare vasculitis.…”

Section: Sirmentioning

confidence: 94%