Avtor/Urednik		Dillon, MJ
Naslov		Renovascular hypertension
Prevedeni naslov		Renovaskularna hipertenzija
Tip		članek
Vir		Slov Pediatr
Vol. in št.		Letnik 7, št. Suppl 1
Leto izdaje		2000
Obseg		str. 186-90
Jezik		eng
Abstrakt		Renovascular disease is the underlying cause of hypertension in 10% of children referred to major centres for evaluation and treatment of high blood pressure. It is second only to coarctation of the aorta as a cause of surgically remediable hypertension in children and the most common abnormality is some form of renal artery stenosis. Fibromuscular dysplasia is the most common underlying cause and in 70% of cases the disease is bilateral and in over 75% there is intrarenal arterial involvement. There is also a recognised association with middle aortic syndrome and cerebrovascular disease. A wide spectrum of investigative procedures are available for evaluating such patients including Doppler ultrasonography, captopril primed isotope renography, renal vein renin sampling and selective renal angiography. The role of magnetic resonance angiography and computerised tomographic and spiral angiography is less clear. Antihypertensive drug therapy is almost always required but in addition revascularization surgery and intraluminal angioplasty is increasingly utilized to improve the arterial supply to the affected kidney or kidneys. However, there are some patients in whom nephrectomy is necessary and others in whom surgical intervention is contraindicated and medical management has to be maintained. Although children with renovascular disease comprise only a small proportion of all children with hypertension, they are an important group since there is the potential for surgical or interventional radiological cure in selected cases. It is also apparent that although the renal arteries are affected the disease process can involve other vessels and can also be part of a number of syndromes with their own additional features and long-term implications.
Izvleček		Renovaskularna bolezen je vzrok za hipertenzijo pri 10% otrok, ki jih napotijo v večje centre zaradi preiskav in zdravljenja zvišanega krvnega tlaka. Glede na renovaskularno bolezen je samo koarktacija aorte pri otrocih pogostejši vzrok hipertenzije, ki se jo da kirurško zdraviti. Najpogostejša nepravilnost pri renovaskularni bolezni je ena od oblik stenoze ledvične arterije. V večini primerov gre za fibromuskularno displazijo, v 70%je bolezen bilateralna in v več kot 75% gre za prizadetost intrarenalnih arterij. Dobro je znana tudi povezava s sindromom srednje aorte in cerebrovaskularno boleznijo. Za preiskovanje bolnikov z renovaskularno hipertenzijo je na razpolago precej diagnostičnih metod: Dopplerjeva sonografija, izotopna renografija s kaptoprilom, določanje renina v ledvičnih venah in selektivna ledvična angiografija. Manj jasna je vloga angiografije z magnetno resonanco, računalniške tomografije in spiralne angiografije. Skoraj vedno je potrebno antihipertenzivno zdravljenje, razen tega pa se vedno bolj uporablja tudi kirurška revaskularizacija in intraluminalna angioplastika, na ta način se izboljša arterijska oskrba prizadete ledvice oziroma ledvic. Pri nekaterih bolnikih je treba narediti nefrektomijo, pri drugih pa je kirurški poseg kontraindiciran in morajo biti zdravljeni z antihipertenzivnimi zdravili. Čeprav predstavljajo otroci z renovaskularno boleznijo le majhen del vseh otrok s hipertenzijo, so pomembna skupina, ker obstaja možnost, da pri izbranih primerih uporabimo kirurško ali intervencijo radiološko zdravljenje. Jasno je tudi, da lahko bolezen prizadene ne samo ledvične, ampak tudi druge arterije in je lahko tudi del številnih sindromov, ki imajo svojo lastno klinično sliko in prognozo.
Deskriptorji		HYPERTENSION, RENOVASCULAR RENAL ARTERY OBSTRUCTION CHILD FIBROMUSCULAR DYSPLASIA