Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Renal and Renovascular Hypertension in Children

소아의 신성 고혈압

  • Hahn, Hye-Won (Department of Pediatrics, Eulji University School of Medicine)
  • 한혜원 (을지대학교 의과대학 소아청소년과)
  • Received : 2011.03.25
  • Accepted : 2011.04.14
  • Published : 2011.04.30
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Abstract

Hypertension is a major risk factor of atherosclerosis which results in cardiovascular disease, and remains a major health problem worldwide. While children are more likely to have secondary hypertension, recent studies support the theory that the prevalence of essential hypertension in children and adolescents is increasing with the global epidemic of childhood obesity, and close attention is needed. Evaluation of hypertension in the pediatric age group should be guided by the age at presentation, and renal diseases must be considered in every child with hypertension, because of the prevalence of renovascular and renal parenchymal disorders as the etiology in any age group. The majority of children with chronic kidney disease are hypertensive, and many have associated end organ damage. Thus, once hypertension has been confirmed, end organ care as well as pharmacologic therapy must be continued. In renovascular hypertension, as cure could be gained with surgical/endovascular intervention, accurate diagnosis is important and it is recommended that every suspected child should undergo angiography.

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References

  1. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(2 Suppl 4th Report):555-76. https://doi.org/10.1542/peds.114.2.S2.555
  2. Londe S. Causes of hypertension in the young. Pediatr Clin North Am 1978;25:55-65. https://doi.org/10.1016/S0031-3955(16)33532-5
  3. Din-Dzietham R, Liu Y, Bielo MV, Shamsa F. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation 2007;116:1488-96. https://doi.org/10.1161/CIRCULATIONAHA.106.683243
  4. Flynn JT. Pediatric hypertension update. Curr Opin Nephrol Hypertens 2010;19:292-7. https://doi.org/10.1097/MNH.0b013e3283373016
  5. Feber J, Ahmed M. Hypertension in children: new trends and challenges Clin Sci (Lond) 2010;119:151-61. https://doi.org/10.1042/CS20090544
  6. Chiolero A, Bovet P, Paradis G, Paccaud F. Has blood pressure increased in children in response to the obesity epidemic? Pediatrics 2007;119:544-53. https://doi.org/10.1542/peds.2006-2136
  7. Flynn JT. Hypertension in the young: epidemiology, sequelae and therapy. Nephrol Dial Transplant 2009;24:370-5.
  8. Assadi F. Relation of left ventricular hypertrophy to microalbuminuria and C-reactive protein in children and adolescents with essential hypertension. Pediatr Cardiol 2008; 29:580-4. https://doi.org/10.1007/s00246-007-9153-4
  9. Lubrano R, Travasso E, Raggi C, Guido G, Masciangelo R, Elli M. Blood pressure load, proteinuria and renal function in pre-hypertensive children. Pediatr Nephrol 2009;24: 823-31. https://doi.org/10.1007/s00467-008-1077-6
  10. Feld LG, Springate JE. Hypertension in children. Curr Probl Pediatr 1988;18:317-73.
  11. Rames LK, Clarke WR, Connor WE, Reiter MA, Lauer RM. Normal blood pressure and the evaluation of sustained blood pressure elevation in childhood: the Muscatine study. Pediatrics 1978;61:245-51.
  12. Tullus K, Brennan E, Hamilton G, Lord R, McLaren CA, Marks SD, et al. Renovascular hypertension in children. Lancet 2008;371: 1453-63. https://doi.org/10.1016/S0140-6736(08)60626-1
  13. Stadermann MB, Montini G, Hamilton G, Roebuck DJ, McLaren CA, Dillon MJ, et al. Results of surgical treatment for renovascular hypertension in children: 30 year single centre experience. Nephrol Dial Transplant 2010;25:807-13. https://doi.org/10.1093/ndt/gfp537
  14. Baumgartner I, Lerman LO. Renovascular hypertension: screening and modern management. Eur Heart J 2011 Jan 27 [E pub ahead of print].
  15. Plouin PF, Perdu J, La Batide-Alanore A, Boutouyrie P, Gimenez-Roqueplo AP, Jeunemaitre X. Fibromuscular dysplasia. Orphanet J Rare Dis 2007;2:28. https://doi.org/10.1186/1750-1172-2-28
  16. Ingelfinger JR, Newburger JW. Spectrum of renal anomalies in patients with Williams syndrome. J Pediatr 1991;119:771-3. https://doi.org/10.1016/S0022-3476(05)80299-9
  17. Deal JE, Snell MF, Barratt TM, Dillon MJ. Renovascular disease in childhood. J Pediatr 1992;121:378-84. https://doi.org/10.1016/S0022-3476(05)81789-5
  18. Slovut DP, Olin JW. Fibromuscular dysplasia. N Engl J Med 2004 29;350:1862-71.
  19. D'Souza SJ, Tsai WS, Silver MM, Chait P, Benson LN, Silverman E, et al. Diagnosis and management of stenotic aorto-arteriopathy in childhood. J Pediatr 1998;132: 1016-22. https://doi.org/10.1016/S0022-3476(98)70401-9
  20. Deal JE, Sever PS, Barratt TM, Dillon MJ. Phaeochromocytoma--investigation and management of 10 cases. Arch Dis Child 1990;65:269-74. https://doi.org/10.1136/adc.65.3.269
  21. Koskimies O. Arterial hypertension developing 10 years after radiotherapy for Wilms's tumour. Br Med J (Clin Res Ed. 1982;285: 996-8. https://doi.org/10.1136/bmj.285.6347.996
  22. Sozen H, Dalgic A, Karakayali H, Baskin E, Saatci U, Arslan G, et al. Renal transplantation in children. Transplant Proc 2006;38: 426-9. https://doi.org/10.1016/j.transproceed.2006.01.014
  23. Han M, Criado E. Renal artery stenosis and aneurysms associated with neurofibromatosis. J Vasc Surg 2005;41:539-43. https://doi.org/10.1016/j.jvs.2004.12.021
  24. Nystrom HC, Jia J, Johansson M, Lambert G, Bergstrom G. Neurohormonal influences on maintenance and reversal of two-kidney one-clip renal hypertension. Acta Physiol Scand 2002;175:245-51. https://doi.org/10.1046/j.1365-201X.2002.00997.x
  25. Higashi Y, Sasaki S, Nakagawa K, Matsuura H, Oshima T, Chayama K. Endothelial function and oxidative stress in renovascular hypertension. N Engl J Med 2002;346: 1954-62. https://doi.org/10.1056/NEJMoa013591
  26. Tullus K, Roebuck DJ, McLaren CA, Marks SD. Imaging in the evaluation of renovascular disease. Pediatr Nephrol 2010;25:1049-56. https://doi.org/10.1007/s00467-009-1320-9
  27. Brun P, Kchouk H, Mouchet B, Baudouin V, Raynaud A, Loirat C, et al. Value of Doppler ultrasound for the diagnosis of renal artery stenosis in children. Pediatr Nephrol 1997; 11:27-30. https://doi.org/10.1007/s004670050227
  28. Gao J, Ng A, Shih G, Goldstein M, Kapur S, Wang J, et al. Intrarenal color duplex ultrasonography: a window to vascular complications of renal transplants. J Ultrasound Med 2007;26:1403-18. https://doi.org/10.7863/jum.2007.26.10.1403
  29. Dellegrottaglie S, Sanz J, Macaluso F, Einstein AJ, Raman S, Simonetti OP, et al. Technology Insight: magnetic resonance angiography for the evaluation of patients with peripheral artery disease. Nat Clin Pract Cardiovasc Med 2007;4:677-87. https://doi.org/10.1038/ncpcardio1035
  30. Vo NJ, Hammelman BD, Racadio JM, Strife CF, Johnson ND. Anatomic distribution of renal artery stenosis in children: implications for imaging. Pediatr Radiol 2006;36: 1032-6. https://doi.org/10.1007/s00247-006-0253-8
  31. Wong H, Hadi M, Khoury T, Geary D, Rubin B, Filler G. Management of severe hypertension in a child with tuberous sclerosisrelated major vascular abnormalities. J Hypertens 2006;24:597-9. https://doi.org/10.1097/01.hjh.0000209994.33680.11
  32. Konig K, Gellermann J, Querfeld U, Schneider MB. Treatment of severe renal artery stenosis by percutaneous transluminal renal angioplasty and stent implantation: review of the pediatric experience: apropos of two cases. Pediatr Nephrol 2006;21:663-71. https://doi.org/10.1007/s00467-006-0010-0
  33. Hughes RJ, Scoble JE, Reidy JF. Renal angioplasty in non-atheromatous renal artery stenosis: technical results and clinical outcome in 43 patients. Cardiovasc Intervent Radiol 2004;27:435-40.
  34. Watson AR, Balfe JW, Hardy BE. Renovascular hypertension in childhood: a changing perspective in management. J Pediatr 1985; 106:366-72. https://doi.org/10.1016/S0022-3476(85)80658-2
  35. Tyagi S, Kaul UA, Satsangi DK, Arora R. Percutaneous transluminal angioplasty for renovascular hypertension in children: initial and long-term results. Pediatrics 1997;99: 44-9. https://doi.org/10.1542/peds.99.1.44
  36. Ing FF, Goldberg B, Siegel DH, Trachtman H, Bierman FZ. Arterial stents in the management of neurofibromatosis and renovascular hypertension in a pediatric patient: case report of a new treatment modality. Cardiovasc Intervent Radiol 1995;18:414-8. https://doi.org/10.1007/BF00338313
  37. Imamura H, Isobe M, Takenaka H, Kinoshita O, Sekiguchi M, Ohta M. Successful stenting of bilateral renal artery stenosis due to fibromuscular dysplasia assessed by use of pressure guidewire technique: a case report. Angiology 1998;49:69-74. https://doi.org/10.1177/000331979804900109
  38. McLaren CA, Roebuck DJ. Interventional radiology for renovascular hypertension in children. Tech Vasc Interv Radiol 2003;6: 150-7. https://doi.org/10.1053/j.tvir.2003.10.007
  39. Stanley JC, Zelenock GB, Messina LM, Wakefield TW. Pediatric renovascular hypertension: a thirty-year experience of operative treatment. J Vasc Surg 1995;21:212-26; discussion 26-7. https://doi.org/10.1016/S0741-5214(95)70263-6
  40. McTaggart SJ, Gulati S, Walker RG, Powell HR, Jones CL. Evaluation and long-term outcome of pediatric renovascular hypertension. Pediatr Nephrol 2000;14:1022-9. https://doi.org/10.1007/s004670050066
  41. Trinquart L, Mounier-Vehier C, Sapoval M, Gagnon N, Plouin PF. Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: a systematic review and meta-analysis. Hypertension 2010;56: 525-32. https://doi.org/10.1161/HYPERTENSIONAHA.110.152918
  42. Arar MY, Hogg RJ, Arant BS, Jr., Seikaly MG. Etiology of sustained hypertension in children in the southwestern United States. Pediatr Nephrol 1994;8:186-9. https://doi.org/10.1007/BF00865475
  43. Simoes e Silva AC, Silva JM, Diniz JS, Pinheiro SV, Lima EM, Vasconcelos MA, et al. Risk of hypertension in primary vesicoureteral reflux. Pediatr Nephrol 2007;22:459-62. https://doi.org/10.1007/s00467-006-0349-2
  44. Warnock DG. Liddle syndrome: genetics and mechanisms of Na+ channel defects. Am J Med Sci 2001;322:302-7. https://doi.org/10.1097/00000441-200112000-00002
  45. Dillon MJ, Goonasekera CD. Reflux nephropathy. J Am Soc Nephrol 1998;9:2377-83.
  46. Gordon I. Vesico-ureteric reflux, urinarytract infection, and renal damage in children. Lancet 1995;346:489-90. https://doi.org/10.1016/S0140-6736(95)91328-9
  47. Flynn JT, Mitsnefes M, Pierce C, Cole SR, Parekh RS, Furth SL, et al. Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children study. Hypertension 2008;52: 631-7. https://doi.org/10.1161/HYPERTENSIONAHA.108.110635
  48. Groothoff JW. Long-term outcomes of children with end-stage renal disease. Pediatr Nephrol 2005;20:849-53. https://doi.org/10.1007/s00467-005-1878-9
  49. Griendling KK, Murphy TJ, Alexander RW. Molecular biology of the renin-angiotensin system. Circulation 1993;87:1816-28. https://doi.org/10.1161/01.CIR.87.6.1816
  50. Muller DN, Luft FC. The renin-angiotensin system in the vessel wall. Basic Res Cardiol 1998;93 Suppl 2:7-14. https://doi.org/10.1007/s003950050194
  51. Hadtstein C, Schaefer F. Hypertension in children with chronic kidney disease: pathophysiology and management. Pediatr Nephrol 2008;23:363-71. https://doi.org/10.1007/s00467-007-0643-7
  52. Wolf G, Butzmann U, Wenzel UO. The reninangiotensin system and progression of renal disease: from hemodynamics to cell biology. Nephron Physiol 2003;93:P3-13. https://doi.org/10.1159/000066656
  53. Williams GH. Aldosterone biosynthesis, regulation, and classical mechanism of action. Heart Fail Rev 2005;10:7-13. https://doi.org/10.1007/s10741-005-2343-3
  54. Savoia C, Touyz RM, Amiri F, Schiffrin EL. Selective mineralocorticoid receptor blocker eplerenone reduces resistance artery stiffness in hypertensive patients. Hypertension 2008;51:432-9. https://doi.org/10.1161/HYPERTENSIONAHA.107.103267
  55. Susic D, Varagic J, Ahn J, Matavelli L, Frohlich ED. Long-term mineralocorticoid receptor blockade reduces fibrosis and improves cardiac performance and coronary hemodynamics in elderly SHR. Am J Physiol Heart Circ Physiol 2007;292:H175-9. https://doi.org/10.1152/ajpheart.00660.2006
  56. Alvarez-Lara MA, Martin-Malo A, Espinosa M, Rodriguez-Benot A, Aljama P. Blood pressure and body water distribution in chronic renal failure patients. Nephrol Dial Transplant 2001;16 Suppl 1:94-7. https://doi.org/10.1093/ndt/16.suppl_1.94
  57. Weidmann P. Pathogenesis of hypertension associated with chronic renal failure. Contrib Nephrol 1984;41:47-65.
  58. Dubinion JH, Mi Z, Jackson EK. Role of renal sympathetic nerves in regulating renovascular responses to angiotensin II in spontaneously hypertensive rats. J Pharmacol Exp Ther 2006;317:1330-6. https://doi.org/10.1124/jpet.106.101279
  59. Campese VM, Krol E. Neurogenic factors in renal hypertension. Curr Hypertens Rep 2002;4:256-60. https://doi.org/10.1007/s11906-002-0016-3
  60. Boero R, Pignataro A, Ferro M, Quarello F. Sympathetic nervous system and chronic renal failure. Clin Exp Hypertens 2001;23: 69-75. https://doi.org/10.1081/CEH-100001198
  61. Miyajima E, Yamada Y, Yoshida Y, Matsukawa T, Shionoiri H, Tochikubo O, et al. Muscle sympathetic nerve activity in renovascular hypertension and primary aldosteronism. Hypertension 1991;17:1057-62. https://doi.org/10.1161/01.HYP.17.6.1057
  62. Carlini RG, Reyes AA, Rothstein M. Recombinant human erythropoietin stimulates angiogenesis in vitro. Kidney Int 1995;47: 740-5. https://doi.org/10.1038/ki.1995.113
  63. Vaziri ND. Mechanism of erythropoietininduced hypertension. Am J Kidney Dis 1999;33:821-8. https://doi.org/10.1016/S0272-6386(99)70413-0
  64. Sato A, Suzuki H, Murakami M, Nakazato Y, Iwaita Y, Saruta T. Glucocorticoid increases angiotensin II type 1 receptor and its gene expression. Hypertension 1994;23:25-30. https://doi.org/10.1161/01.HYP.23.1.25
  65. Krakoff L, Nicolis G, Amsel B. Pathogenesis of hypertension in Cushing's syndrome. Am J Med 1975;58:216-20. https://doi.org/10.1016/0002-9343(75)90572-0
  66. Scherrer U, Vissing SF, Morgan BJ, Rollins JA, Tindall RS, Ring S, et al. Cyclosporineinduced sympathetic activation and hypertension after heart transplantation. N Engl J Med 1990;323:693-9. https://doi.org/10.1056/NEJM199009133231101
  67. Busauschina A, Schnuelle P, van der Woude FJ. Cyclosporine nephrotoxicity. Transplant Proc 2004;36:229S-33S. https://doi.org/10.1016/j.transproceed.2004.01.021
  68. Johannsson G, Sverrisdottir YB, Ellegard L, Lundberg PA, Herlitz H. GH increases extracellular volume by stimulating sodium reabsorption in the distal nephron and preventing pressure natriuresis. J Clin Endocrinol Metab 2002;87:1743-9. https://doi.org/10.1210/jc.87.4.1743
  69. Charra B, Bergstrom J, Scribner BH. Blood pressure control in dialysis patients: importance of the lag phenomenon. Am J Kidney Dis 1998;32:720-4. https://doi.org/10.1016/S0272-6386(98)70147-7
  70. Bartosh SM, Aronson AJ. Childhood hypertension. An update on etiology, diagnosis, and treatment. Pediatr Clin North Am 1999; 46:235-52. https://doi.org/10.1016/S0031-3955(05)70115-2
  71. Woroniecki RP, Flynn JT. How are hypertensive children evaluated and managed? A survey of North American pediatric nephrologists. Pediatr Nephrol 2005;20:791-7. https://doi.org/10.1007/s00467-004-1804-6
  72. Ligtenberg G, Blankestijn PJ, Oey PL, Klein IH, Dijkhorst-Oei LT, Boomsma F, et al. Reduction of sympathetic hyperactivity by enalapril in patients with chronic renal failure. N Engl J Med 1999;340:1321-8. https://doi.org/10.1056/NEJM199904293401704
  73. Nakao N, Yoshimura A, Morita H, Takada M, Kayano T, Ideura T. Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial. Lancet 2003; 361:117-24. https://doi.org/10.1016/S0140-6736(03)12229-5
  74. Campbell R, Sangalli F, Perticucci E, Aros C, Viscarra C, Perna A, et al. Effects of combined ACE inhibitor and angiotensin II antagonist treatment in human chronic nephropathies. Kidney Int 2003;63:1094-103. https://doi.org/10.1046/j.1523-1755.2003.00832.x
  75. Lubrano R, Soscia F, Elli M, Ventriglia F, Raggi C, Travasso E, et al. Renal and cardiovascular effects of angiotensin-converting enzyme inhibitor plus angiotensin II receptor antagonist therapy in children with proteinuria. Pediatrics 2006;118:e833-8. https://doi.org/10.1542/peds.2005-2053
  76. Sahney S. A review of calcium channel antagonists in the treatment of pediatric hypertension. Paediatr Drugs 2006;8:357-73. https://doi.org/10.2165/00148581-200608060-00004
  77. Krum H, Nolly H, Workman D, He W, Roniker B, Krause S, et al. Efficacy of eplerenone added to renin-angiotensin blockade in hypertensive patients. Hypertension 2002; 40:117-23. https://doi.org/10.1161/01.HYP.0000025146.19104.FE
  78. Pitt B, White H, Nicolau J, Martinez F, Gheorghiade M, Aschermann M, et al. Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure. J Am Coll Cardiol 2005;46:425-31. https://doi.org/10.1016/j.jacc.2005.04.038
  79. Nussberger J, Wuerzner G, Jensen C, Brunner HR. Angiotensin II suppression in humans by the orally active renin inhibitor Aliskiren (SPP100): comparison with enalapril. Hypertension 2002;39:E1-8. https://doi.org/10.1161/hy0102.102293
  80. Stanton A, Jensen C, Nussberger J, O'Brien E. Blood pressure lowering in essential hypertension with an oral renin inhibitor, aliskiren. Hypertension 2003;42:1137-43. https://doi.org/10.1161/01.HYP.0000101688.17370.87
  81. Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K, et al. Catheterbased renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 2009;373:1275-81. https://doi.org/10.1016/S0140-6736(09)60566-3
  82. Paulis L, Unger T. Novel therapeutic targets for hypertension. Nat Rev Cardiol 2010;7: 431-41. https://doi.org/10.1038/nrcardio.2010.85