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Journal of Medicine and Life 2009Renovascular hypertension in children is a very rare illness. It occurs as a result of the imbalance between hypotensive and hypertensive systems. Renal ischaemia (95%... (Review)
Review
INTRODUCTION
Renovascular hypertension in children is a very rare illness. It occurs as a result of the imbalance between hypotensive and hypertensive systems. Renal ischaemia (95% of the cases) and the shortening of hipotensive factors (5% of the cases) are responsible for the production mechanism of renovascular hypertension in children. In order to make an early diagnosis regarding the renovascular hypertension in all children suffering from renovascular illnesses, blood pressure must be taken correctly and repeatedly.
MATERIALS AND METHODS
This paper is a case study on 19 children with renovascular hypertension, aged between 2 and 15 years old. Most cases were divided into two groups: subjects aged 4-7 years old and subjects aged 8-12 years old. Each group represents 34.2% of all cases. The diagnosis of renovascular hypertension in those 19 children was established after correctly taking the blood pressure and comparing it with the normal values for each age. Hypertension was diagnosed before knowing its cause in 8 neglected cases. The blood pressure was repeatedly taken in the other 11 children suffering from renovascular illnesses and the diagnosis of hypertension was early established when blood pressure values increased. Previously, blood pressure was normal in these 11 cases.
RESULTS
The etiopathogenical diagnosis showed parenchymal diseases in 12 cases--63.1%. Seven patients suffered from renovascular lesions--36.9%. Laboratory exams, radiology, imagistic exams, arteriography and scintigraphy were steps taken in order to establish the etiopathogenical diagnosis. These exams showed the next direct causes of renovascular hypertension: bilateral chronic pyelonephritis in 4 cases--21.4%, hydronephrosis in 3 cases--16.2%, congenital renal hypoplasia in 2 cases--10.4% and doubled kidney in 2 cases--10.4%. The other 8 cases presented acute glomerulonephritis, unilateral renal agenesis, horseshoe kidney, unilateral pyelonephritis, renal artery agenesis, renal trauma, renal abcess and Wilms tumor, one case of each illness--5.2%. The major complications were: retinopathy, chronic renal failure and stroke.
CONCLUSIONS
Laboratory data are just a hint in diagnosing renovascular hypertension. However, radiology, imagistic exams, arteriography and scintigraphy are compulsory in the renourinary status and etiopathogenical diagnosis.
Topics: Adolescent; Angiography; Blood Pressure; Child; Child, Preschool; Female; Humans; Hypertension, Renovascular; Male; Urography
PubMed: 20108487
DOI: No ID Found -
Radiation Oncology (London, England) Feb 2021Radiation nephropathy (RN) is a kidney injury induced by ionizing radiation. In a clinical setting, ionizing radiation is used in radiotherapy (RT). The use and the... (Review)
Review
Radiation nephropathy (RN) is a kidney injury induced by ionizing radiation. In a clinical setting, ionizing radiation is used in radiotherapy (RT). The use and the intensity of radiation therapy is limited by normal-tissue damage including kidney toxicity. Different thresholds for kidney toxicity exist for different entities of RT. Histopathologic features of RN include vascular, glomerular and tubulointerstitial damage. The different molecular and cellular pathomechanisms involved in RN are not fully understood. Ionizing radiation causes double-stranded breaks in the DNA, followed by cell death including apoptosis and necrosis of renal endothelial, tubular and glomerular cells. Especially in the latent phase of RN oxidative stress and inflammation have been proposed as putative pathomechanisms, but so far no clear evidence was found. Cellular senescence, activation of the renin-angiotensin-aldosterone-system and vascular dysfunction might contribute to RN, but only limited data is available. Several signalling pathways have been identified in animal models of RN and different approaches to mitigate RN have been investigated. Drugs that attenuate cell death and inflammation or reduce oxidative stress and renal fibrosis were tested. Renin-angiotensin-aldosterone-system blockade, anti-apoptotic drugs, statins, and antioxidants have been shown to reduce the severity of RN. These results provide a rationale for the development of new strategies to prevent or reduce radiation-induced kidney toxicity.
Topics: Animals; Cellular Senescence; DNA Damage; Fibrosis; Humans; Hypertension, Renovascular; Inflammation; Kidney; Oxidative Stress; Radiation Injuries; Radiotherapy; Renin-Angiotensin System
PubMed: 33632272
DOI: 10.1186/s13014-021-01764-y -
Cleveland Clinic Journal of Medicine Dec 2005There is considerable controversy about how to test for renovascular hypertension and, with the development of percutaneous transluminal renal angioplasty (PTRA) and... (Review)
Review
There is considerable controversy about how to test for renovascular hypertension and, with the development of percutaneous transluminal renal angioplasty (PTRA) and stenting, how to treat it. Which noninvasive diagnostic test should be considered, and when is renal angiography called for? Which patients will benefit from conservative medical therapy, and when is PTRA appropriate?
Topics: Humans; Hypertension, Renovascular
PubMed: 16392728
DOI: 10.3949/ccjm.72.12.1135 -
Journal of Clinical Hypertension... Jul 2008Chronic kidney disease is both a cause and a consequence of hypertension. Extracellular volume expansion is an important, if not the most important, contributing factor... (Review)
Review
Chronic kidney disease is both a cause and a consequence of hypertension. Extracellular volume expansion is an important, if not the most important, contributing factor to hypertension seen in chronic kidney disease. Beyond volume expansion, chronic kidney disease-related hypertension is without truly defining characteristics. Consequently, the sequencing of antihypertensive medications for the patient with chronic kidney disease and hypertension becomes arbitrary. Prescription practice in such patients should be mindful of the need for multiple drug classes with at least one of them being a diuretic. Blood pressure goals in the patient with chronic kidney disease and hypertension are set at lower levels than those for patients with essential hypertension alone. It remains to be determined to what level blood pressure should be lowered in the patient with chronic kidney disease, however.
Topics: Antihypertensive Agents; Comorbidity; Humans; Hypertension, Renovascular; Kidney; Renal Insufficiency, Chronic; Risk Factors; United States
PubMed: 18607140
DOI: 10.1111/j.1751-7176.2008.08189.x -
Iranian Journal of Medical Sciences May 2021Captopril, an angiotensin-converting enzyme inhibitor, and losartan, an angiotensin II receptor blocker, are used for the treatment of hypertension, but their effects on...
BACKGROUND
Captopril, an angiotensin-converting enzyme inhibitor, and losartan, an angiotensin II receptor blocker, are used for the treatment of hypertension, but their effects on cardiac stereology are unknown. This study, therefore, aimed to examine their effects on cardiac stereology in rats with renovascular hypertension.
METHODS
This study was conducted at Histomorphometry and Stereology Research Centre, and Cardiovascular Pharmacology Research Lab, Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, in August 2015 to August 2016. Fourty-eight rats were allocated to six groups (n=8 per each group): a sham group, which received a vehicle (distilled water) and five renal artery-clipped groups, which received the vehicle, captopril (50 or 100 mg/ kg/day), or losartan (25 or 50 mg/kg/day). After four weeks, the animals' systolic blood pressures (mm Hg) were measured, and the total volumes of their heart, myocardium, endocardium, matrix, and myocardial vessels (mm), as well as the number of their cardiomyocytes, and Purkinje fibers were determined. Data were analyzed using one-way analysis of variance (ANOVA) followed by least significant difference (LSD) test. P value of equal to or less than 0.05 was considered significant.
RESULTS
The renal artery-clipped rats receiving the vehicle had a significantly higher systolic blood pressure (P<0.001); heart weight (g) (P<0.001); and total volume of the heart (P<0.001), myocardium (P=0.020), endocardium (P=0.009), and myocardial vessels (P=0.008); as well as a significantly lower number of cardiomyocytes (P=0.010) and Purkinje cells (P=0.005), than did the rats in the sham group. The renal artery-clipped rats receiving captopril or losartan had a significantly lower systolic blood pressure (P<0.001), heart weight (P=0.007), and total volume of the heart (P<0.001), myocardium (P<0.001), endocardium (P=0.027), and myocardial vessels (P=0.004) than did the renal artery-clipped rats receiving the vehicle. Neither captopril nor losartan prevented a reduction in the number of Purkinje cells, but captopril at the higher dose attenuated cardiomyocyte loss (P=0.010).
CONCLUSION
Captopril and losartan lowered the systolic blood pressure and cardiac hypertrophy but failed to prevent Purkinje cell loss. Captopril only at the higher dose prevented cardiomyocyte loss. Captopril exerted a greater inhibitory effect on cardiac stereology, which warrants further research.
Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Animals; Captopril; Disease Models, Animal; Heart; Hypertension, Renovascular; Iran; Losartan; Male; Rats; Rats, Sprague-Dawley
PubMed: 34083849
DOI: 10.30476/ijms.2020.81948.0 -
Kidney & Blood Pressure Research 2017Renovascular hypertension (RVHT) is an important cause of childhood hypertension. This study evaluated the clinical characteristics and outcomes of Korean children with...
BACKGROUND/AIMS
Renovascular hypertension (RVHT) is an important cause of childhood hypertension. This study evaluated the clinical characteristics and outcomes of Korean children with RVHT.
METHODS
Children treated for RVHT between 2000 and 2015 at our center were retrospectively reviewed.
RESULTS
Forty-six children were followed for a median of 6.5 (0.66-27.23) years. Forty-five percutaneous transluminal angioplasties (PTAs) were performed in 32 children. At the last visit, clinical benefit was observed in 53.3% of children. Patients with comorbid cerebrovascular disease (CVD) showed less favorable long-term outcomes after PTA (clinical benefit in 41.7% vs. 61.1% in others) and higher restenosis rates (50% vs. 31.6% in others). Surgical procedures (bypass or nephrectomy) were performed in 8 patients. After surgery, blood pressure was normalized in 2 patients, improved in 3 patients, and unchanged in the remaining patients. Between PTA group (n=21) and medication group (n=14), percentage of atrophic kidneys became higher after follow-up period in medication group than in PTA group (60.0% vs. 26.1%, P=0.037).
CONCLUSION
Aggressive treatment of pediatric RVHT yielded fair outcomes in our cohort. CVD comorbidity was associated with relatively poor PTA outcomes. To confirm our findings, larger cohort studies with a longer follow-up period are warranted.
Topics: Adolescent; Angioplasty; Cerebrovascular Disorders; Child; Child, Preschool; Comorbidity; Female; Follow-Up Studies; Humans; Hypertension, Renovascular; Infant; Male; Republic of Korea; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 28950261
DOI: 10.1159/000481549 -
Romanian Journal of Morphology and... 2011Renovascular hypertension (RVH) is very often an under-diagnosed condition, being discovered incidentally, at a routine medical check-up or during a medical examination...
Renovascular hypertension (RVH) is very often an under-diagnosed condition, being discovered incidentally, at a routine medical check-up or during a medical examination for another disease. A number of 217 biological samples (kidney and renal pelvis) resulting from the nephrectomies performed during the period 2008-2009 in the Urology Clinic of Oradea County Hospital have been taken into study. These samples were processed in the Pathology Laboratory of the same hospital. The distribution of nephrectomies according to the urological diagnosis has shown that 38.2% of the patients underwent surgical procedure for renal parenchymal malignant tumor (Grawitz tumor). Out of the 83 nephrectomies caused by renal tumor, in eight cases, benign and malignant angiosclerosis histological changes were seen, which demonstrates a long evolution of hypertension. Its clinical symptoms were masked by those triggered by the tumor. Histopathological changes of benign nephroangiosclerosis with arteriolar vasospasm associated with edema of the wall and/or hypertrophy of the intima with the formation of hyaline deposits were found in three nephrectomies due to hydronephrosis. The pathological study carried on samples obtained from nephrectomies showed that the symptoms of RVH are hidden or accompanied by clinical manifestations of a surgical disease. The percentage of 8.8% of the patients that had histopathologic changes or malignant of benign nephroangio-sclerosis and suffered nephrectomies for a surgical disease is quite small compared to the large number of nephrectomies. It is imperative to identify in due time the secondary mechanism of hypertension in order to perform the surgical intervention which saves the kidney or prevents the extension to other organs. Although no special investigations were performed showing a possible preoperative RVH, it can be stated that the renal origin of the arterial hypertension can be established retrospectively, after nephrectomy. The monitoring of blood pressure values during several years is extremely important for establishing the etiology of renal hypertension.
Topics: Adult; Aged; Female; Humans; Hypertension, Renovascular; Kidney Glomerulus; Male; Middle Aged; Nephrectomy
PubMed: 21424082
DOI: No ID Found -
International Journal of Experimental... Aug 2007Menopause and hypertension independently alter cardiovascular remodelling, but little is known about their effect on left ventricular and aortic wall remodelling....
Menopause and hypertension independently alter cardiovascular remodelling, but little is known about their effect on left ventricular and aortic wall remodelling. Eight-weeks-old Wistar rats were divided into four groups of six animals each: Sham group, OVX group (ovariectomized rats), 2K1C (two-kidneys, one-clip rats) and OVX + 2K1C group and kept until 19 weeks. Blood pressure (BP) increased 12% in OVX group, 35% in 2K1C and OVX + 2K1C groups compared with sham group. Vaginal cytology showed Sham and 2K1C rats cycling normally, whereas OVX and OVX + 2K1C rats were persistently in dioestrus or proestrus. At euthanasia, left ventricle (LV) and thoracic aorta were removed and analysed (immunohistochemistry and stereology). LV mass/tibia length ratio and cross-sectional area of cardiomyocytes increased in all groups except Sham. The intramyocardial vascularization reduced 30% in comparison with Sham group, with no difference among OVX, 2K1C and OVX + 2K1C groups. The cardiac interstitium increased more than 45% in both 2K1C and OVX + 2K1C groups compared with Sham, but there was no significant difference between Sham and OVX groups. Nuclei number of LV cardiomyocyte diminished in OVX group, followed by 2K1C group and OVX + 2K1C group, with no difference between the 2K1C and the OVX + 2K1C groups. There was positive immunostaining for angiotensin II AT1 receptor in smooth muscle cell layer of aortic tunica media in all groups. These results show that both ovariectomy and renovascular hypertension enhance BP as a single stimulus and therefore produce adverse cardiac remodelling. However, renovascular hypertension exerts a far greater influence than surgically-induced menopause in this parameter.
Topics: Animals; Aorta; Blood Pressure; Female; Hypertension, Renovascular; Hypertrophy, Left Ventricular; Menopause; Myocytes, Cardiac; Ovariectomy; Rats; Rats, Wistar; Uterus; Vagina; Ventricular Remodeling
PubMed: 17696911
DOI: 10.1111/j.1365-2613.2007.00546.x -
Journal of Clinical Hypertension... Apr 2018Myeloproliferative neoplasms (MPNs) with Janus kinase 2 (JAK2) mutation are associated with a high risk for occlusive vascular diseases. We report 2 cases of... (Review)
Review
Myeloproliferative neoplasms (MPNs) with Janus kinase 2 (JAK2) mutation are associated with a high risk for occlusive vascular diseases. We report 2 cases of renovascular hypertension associated with JAK2 V617F mutation-positive MPNs and provide a literature review. In Case 1, a 63-year-old woman had resistant hypertension, massive proteinuria, and erythrocytosis. Evaluations revealed right renal artery stenosis causing renovascular hypertension and polycythemia vera with JAK2 V617F mutation. Renin-angiotensin system inhibitors and subsequent angioplasty controlled the blood pressure and the proteinuria resolved. In Case 2, a 74-year-old woman had resistant hypertension and thrombocytosis. Evaluations confirmed left renal artery stenosis and essential thrombocythemia with JAK2 V617F. Angioplasty cured the hypertension. A literature review of 18 cases revealed the following as the most common characteristics of MPN-associated renovascular hypertension: manifests primarily in women; is associated with untreated polycythemia vera and essential thrombocythemia, concomitant leukocytosis, and JAK2 mutation positivity; and is responsive to angioplasty. This report demonstrates that JAK2 mutation-positive MPNs are a less common but important underlying cause of adult renovascular hypertension.
Topics: Aged; Amino Acid Substitution; Angioplasty; Female; Humans; Hypertension, Renovascular; Janus Kinase 2; Middle Aged; Myeloproliferative Disorders; Treatment Outcome
PubMed: 29656438
DOI: 10.1111/jch.13257 -
Hinyokika Kiyo. Acta Urologica Japonica Sep 2000Renovascular disease is one of the most common causes of secondary hypertension. Recent technical advances have changed the management principles, which include a more...
Renovascular disease is one of the most common causes of secondary hypertension. Recent technical advances have changed the management principles, which include a more aggressive approach to the diagnosis and treatment of renovascular hypertension (RVH). We experienced a total of 95 cases with RVH between 1958 and 1999. The mean age of all patients was 31.8 years old, ranging from 3 to 64 years. The three major basal diseases that caused RVH were fibromuscular dysplasia (34/95), arteriosclerosis (26/95), and aortitis (12/95). Ninety-two kidneys were treated in 79 of the 95 patients. The major therapeutic modalities performed were reconstruction of renal artery (6/79), nephrectomy (21/79), autotransplantation (26/79), and percutaneous transluminal angioplasty (PTA) (25/79). PTA is now the treatment of choice for the initial management of patients with RVH. Surgical treatment is generally reserved for patients in whom PTA fails. Pharmacotherapy is used on patients awaiting angioplasty or revascularization, those who are too ill for intervention, and those who have failed to respond to intervention.
Topics: Adolescent; Adult; Angioplasty, Balloon; Child; Child, Preschool; Female; Humans; Hypertension, Renovascular; Kidney Transplantation; Male; Middle Aged; Nephrectomy; Radiography; Renal Artery
PubMed: 11107539
DOI: No ID Found