Avtor/Urednik     Bračič, K; Gregorič, A; Miksič, K; Matela, J
Naslov     Renovaskularna hipertenzija pri otrocih - diagnostični postopek, možnosti in zapleti zdravljenja. Prikaz 3 primerov v letih 1997-2000
Prevedeni naslov     Rrenovascular hypertension in children - diagnostic evaluation, management and complicationes of the treatment. A review of 3 cases in years 1997-2000
Tip     članek
Vir     Slov Pediatr
Vol. in št.     Letnik 7, št. Suppl 1
Leto izdaje     2000
Obseg     str. 191-200
Jezik     slo
Abstrakt     The aim of the study was to show the clinical symptoms, screening tests, angiography findings, therapeutic possibilities and complications in treating renovascular hypertension (RVH) in three children aged 7.8 to 9.4 years, in whom the diagnosis of RVH was assessed at the Maribor Department of Paediatrics between 1997 and 2000. The children, two boys and one girl, were followed for 9-36 months. Clinical presentation includes: asymptomatic hypertension (n=3), abdominal murmur (n=I ). All had severe hypertension demanding a variety of antihypertensive drugs. Of the screening methods, radioisotope scintigraphy without captopril (99Tc-DTPA) was positive in two patients (case 1 and 3), increased peripheral renin activity in one patient (case 1), duplex Doppler sonographic investigation detected no stenosis of renal arteries in any of the three children while a stenosis of the abdominal aorta was found in one child. The diagnosis was made by means of angiography. In one child (case 1 ) we confirmed a stenosis of the main left renal artery and the branch for the inferior kidney pole, with a small left kidney. In the second child we detected (case 2) a stenosis of the abdominal aorta and ostial stenosis of both renal arteries (middle aortic syndrome) with numerous collaterals. In the third child (case 3) we found bilateral stenoses of main renal arteries with an aneurysm and poststenotic dilatations. In case 2 hypertension responded well to antihypertensive drugs and poorly in cases 1 and 3. The effort to dilate the renal arteries with percutaneous transluminal angioplasty (PTA) was unsuccessful in two attempts on one artery in case l, unsuccessful in one attempt on two arteries in case 3 where a rupture of the renal artery occurred during PTA, followcd by a barely controllable hypertensive crisis and renal insufficiency. (Abstract truncated at 2000 characters)
Izvleček     Cilj študije je prikazati klinične simptome, presejalne teste, angiografske izvide, možnosti zdravljenja in zaplete pri zdravljenju renovaskularne hipertenzije pri treh otrocih v starosti 7,8 - 9,4 let, pri katerih je bila ugotovljena diagnoza renovaskularne hipertenzije na Kliničnem oddelku za pediatrijo Maribor med letoma 1997 in 2000. Otroci so bili stari 7,8 - 9,4 leta, dva moškega, eden ženskega spola, spremljali smo jih 9 - 36 mesecev. Klinična predstavitev vključuje: asimptomatsko hipertenzijo (n=3), abdominalni šum (n=1). Vsi so imeli težko hipertenzijo, zaradi katere so jemali več vrst antihipertenzivnih zdravil. Od presejalnih metod je bila radioizotopna scintigrafija brez kaptoprila (99Tc-DTPA) pozitivna pri dveh bolnikih (primer 1 in 3), zvišana periferna aktivnost renina pri enem bolniku (primer 1) z Dopplerjevo ultrazvočno preiskavo (duplex) pa nismo ugotovili zožitve ledvičnih arterij pri nobenem izmed treh otrok, ugotovili pa smo zožitev abdominalne aorte pri enem otroku. Diagnoza je bila postavljena z angiografijo. Pri enem otroku (primer 1 ) smo dokazali zožitev glavnega debla leve ledvične arterije in veje za spodnji pol ledvice, z majhno levo ledvico; pri drugem otroku (primer 2) zožitev abdominalne aorte in obeh ledvičnih arterij na odcepiščih od aorte s številnimi kolateralami (middle aortic syndrom); pri tretjem otroku (primer 3) zožitev obeh glavnih debel ledvičnih arterij z anevrizmo in poststenotičnimi dilatacijami. Hipertenzija se je dobro odzvala na antihipertenzivna zdravila v primeru 2, slabše pa v primeru 1 in 3. Poskus širjenja ledvičnih žil s perkutano transluminalno angioplastiko (PTA) je bil neuspešen v dveh poskusih na eni žili v primeru 1, neuspešen v enem poskusu na dveh žilah v primeru 3, kjer je prišlo do raztrganine ledvične arterije med posegom PTA, težko obvladljive hipertenzivne krize in renalne insuficience. (Izvleček prekinjen pri 2000 znakih)
Deskriptorji     HYPERTENSION, RENOVASCULAR
RENAL ARTERY OBSTRUCTION
FIBROMUSCULAR DYSPLASIA
CHILD
DIAGNOSTIC IMAGING
TOMOGRAPHY, X-RAY COMPUTED
MAGNETIC RESONANCE ANGIOGRAPHY
AORTOGRAPHY
RENAL ARTERY
ULTRASONOGRAPHY, DOPPLER