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Changes in renal function during the development of hypertension and effects of antihypertensive treatment. A case
1Department of Pediatrics, Karolinska Institute, St. Göran's Hospital, Stockholm, Sweden.
Insights
This study tracked renal function in a young girl with chronic glomerulonephritis and developing hypertension. Findings show altered sodium excretion during fixed hypertension, partially improved by propranolol.
Area of Science:
- Nephrology
- Pediatric Hypertension
- Renal Physiology
Background:
- Investigated serial renal function in a pediatric patient with chronic glomerulonephritis and developing hypertension.
- Assessed clearances of inulin (CIn) and para-aminohippuric acid (CPAH), filtration fraction, and sodium excretion under hydropenia and volume expansion.
Observation:
- Initially labile blood pressure progressed to fixed hypertension, requiring propranolol treatment.
- Early hypertension stages showed reduced filtration fraction during hydropenia but normal natriuresis during volume expansion.
Findings:
- Fixed hypertension revealed normal glomerular filtration rate, CPAH, and filtration fraction.
- Exaggerated natriuresis was observed in fixed hypertension, with only partial correction by antihypertensive treatment.
Implications:
- Highlights potential alterations in renal sodium handling in pediatric hypertension secondary to chronic kidney disease.
- Suggests impaired natriuretic response may persist despite antihypertensive therapy in this population.
Abstract:
Renal function was serially investigated during the development of hypertension in a 12.8-year-old girl with chronic glomerulonephritis. Clearances of inulin (CIn) and para-aminohippuric acid (CPAH), filtration fraction, and sodium excretion were measured during hydropenia and isotonic saline volume expansion. Blood pressure was initially labile, but after a few years fixed hypertension developed, and antihypertensive treatment with propranolol was started. During the early stages of hypertension, the filtration fraction during hydropenia was reduced, but the natriuresis during volume expansion was normal. When the hypertension was fixed, glomerular filtration rate, CPAH, and filtration fraction were normal, but the natriuresis was exaggerated. Antihypertensive treatment only partially corrected the natriuresis.