The Etiology of Hypertension in Nonrenovascular Unilateral renal Disease—Two Cases of Renin Induced Hypertension in Congenital Renal Dysplasia

Worck, René; Ibsen, Hans; Andersen, Christina; Ibsen, K. Kaas; Rasmussen, Finn

doi:10.3109/08037059509077579

Cited by 9 publications

(3 citation statements)

References 10 publications

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“…Ischemia-induced renin secretion in the juxtaglomerular apparatus of mature glomeruli and interlobular arteries in the scarred area of dysplastic kidney are suggested mechanism for the hypertension in UMCDK. 24,25 Ectopic renin expression by sensitized macrophages is another contributing factor suggested by Liapis et al 26 Early nephrectomy probably halts the process of induction of hypertension and resulted in early cure.…”

Section: Discussionmentioning

confidence: 99%

Early Nephrectomy in Unilateral Multicystic Dysplastic Kidney in Children Cures Hypertension Early: An Observation

et al. 2017

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Surgery is still indicated as the treatment of choice in subset of patients with unilateral multicystic dysplastic kidney (UMCDK) because of its potential complications and malignant change. The purpose of this study is to present our observation that early nephrectomy may cure hypertension early in children with UMCDK and review the literature. We report here four children (two males and two females) with antenatally diagnosed UMCDK with hypertension, treated in the past 4 years. All have antenatal diagnosis of UMCDK and referred to us after their birth. Diagnosis of hypertension (blood pressure> 95th percentile) was made after 3 months of follow-up in all patients. Nephrectomy was performed in all children in variable time duration. Hypertension, urinary tract infection, and desire of parents were the main indication of surgery. All children showed decrease in the size of their dysplastic kidney with time, but hypertension was persistent and needed antihypertensive drugs; even increase in the doses in successive follow-up. After nephrectomy, three children who were operated early got cured having normal blood pressure within variable time duration, while a child, operated late, still had high blood pressure and needed antihypertensive drugs. Early nephrectomy in recently diagnosed hypertension in UMCDK is advisable and can cure hypertension early. The level of evidence is IV (case series with no comparison group).

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Section: Discussionmentioning

confidence: 99%

Early Nephrectomy in Unilateral Multicystic Dysplastic Kidney in Children Cures Hypertension Early: An Observation

et al. 2017

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“…Worck et al [8] reported two patients exhibiting unilateral renal dysplasia, without renal artery stenosis but with renin-dependent hypertension. However, this case was also different from ours, in that our case did not involve parenchymal dysplasia.…”

Section: Discussionmentioning

confidence: 99%

Unilateral renal angiodysplasia in a girl with hypertension

et al. 2005

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We report a case of very unusual renal vascular anomaly: angiodysplasia. The patient suffered from acute pyelonephritis immediately after birth. Renal ultrasonography, performed at age 1 day, revealed an enlarged left kidney with heterogeneously increased echogenicity, which involuted rapidly in 3 months. At age 10 years, she presented with severe hypertension during a course of acute pyelonephritis. Peripheral plasma renin activity was high. Computed tomographic angiogram revealed a very small but functioning left kidney. A single, narrow, left renal artery did not have focal stenosis. Pathology examination revealed dysplastic arterioles at the subcapsular area. After left nephrectomy, the blood pressure and the plasma renin activity were normalized. In conclusion, this is an unusual case of renal angiodysplasia, which induced renin-dependent hypertension.

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“…Webb et al [74] showed elevated plasma renin in two of his three hypertensive children and the hypertension was successfully treated by nephrectomy. Worck et al reported two similar cases [76].…”

Section: Hypertension In Children With Multi-cystic Dysplastic Kidneymentioning

confidence: 91%

Hypertension in Children with Cystic Kidney Diseases

Seeman

2006

CHYR

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Cystic kidney diseases are one of the most common urogenital malformations and are responsible for a substantial morbidity and mortality. Autosomal recessive polycystic kidney disease (ARPKD), autosomal dominant polycystic kidney disease (ADPKD), multicystic dysplastic kidney (MCDK) and juvenile nephronophthisis (JNP) are the most common and most serious cystic kidney diseases.Hypertension is the main risk factor for progression of various nephropathies, including cystic kidney diseases. The prevalence of hypertension varies depending on the method of BP measurement and the type of cystic disease. Ambulatory BP monitoring (ABPM) is a more potent tool for detection of hypertension than the clinic BP. Hypertension is most common in children with ARPKD, the prevalence ranges between 60 -100% and hypertension accounts for substantial cardiovascular morbidity and mortality in these patients. In children with ADPKD the prevalence of hypertension is 15 -38% despite normal renal function and is the most important treatable factor for progression of the disease. Hypertension is a relative uncommon finding in children with MCDK (0 -20%) and is more often caused by contralateral kidney damage than by affected multicystic kidney. Children with JNP are usually normotensive until the late stages of renal insufficiency.The drugs of first choice in children with cystic kidney diseases are ACE-inhibitors. Most children with ARPKD have severe hypertension and require combination therapy with 2 -4 drugs (beta-blockers, diuretics, calcium channel blockers). Treatment of hypertension is important not only to delay progression of the kidney disease but also to decrease the cardiovascular morbidity and mortality.

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The Etiology of Hypertension in Nonrenovascular Unilateral renal Disease—Two Cases of Renin Induced Hypertension in Congenital Renal Dysplasia

Cited by 9 publications

References 10 publications

Early Nephrectomy in Unilateral Multicystic Dysplastic Kidney in Children Cures Hypertension Early: An Observation

Early Nephrectomy in Unilateral Multicystic Dysplastic Kidney in Children Cures Hypertension Early: An Observation

Unilateral renal angiodysplasia in a girl with hypertension

Hypertension in Children with Cystic Kidney Diseases

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