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[Arterial hypertension. Prevention in infants with congenital urinary tract malformations]
E Kuwertz-Bröking1, R Ernst, M Bulla
1Kinderklinik, Universität Münster.
Insights
Severe hypertension affects over 20% of infants with congenital urinary tract malformations. Early diagnosis and treatment are crucial for managing this condition in newborns.
Area of Science:
- Pediatric Nephrology
- Neonatal Hypertension
- Congenital Urologic Abnormalities
Context:
- Congenital urinary tract malformations are common in newborns.
- Severe hypertension is a significant complication in infants with these conditions.
- Understanding risk factors and diagnostic challenges is vital.
Purpose:
- To investigate the incidence and characteristics of severe hypertension in infants with congenital urinary tract malformations.
- To identify risk factors associated with the development of hypertension.
- To outline diagnostic principles and therapeutic approaches for managing hypertension in this population.
Summary:
- Eighty-nine infants with congenital urinary tract malformations were studied; 22.5% developed severe hypertension within the first year.
- Mean age at diagnosis was 5 months, with elevated blood pressure readings.
- Risk factors included cystic renal malformation, vesico-ureteral reflux, obstructive uropathy, and percutaneous nephrostomy, with hypertension persisting post-surgery.
Impact:
- Highlights the high prevalence of severe hypertension in infants with congenital urinary tract malformations.
- Emphasizes the importance of early detection and management of hypertension in affected infants.
- Provides insights into risk factors and therapeutic strategies for pediatric hypertension specialists.
Abstract:
Eighty-nine newborns and infants with congenital urinary tract malformations were treated in the childrens' hospital of the Westfälische Wilhelms-University from 1986 to 1989. Twenty patients of this group (22.5%) developed severe hypertension requiring treatment within the first year of life. Mean age of diagnosis of hypertension was 5 months (range 0.5-12 months). Median values for blood pressure at time of diagnosis were 138 mmHg (range 120-170) for systolic and 92 mmHg (range 80-110) for diastolic values. Six patients showed characteristic symptoms for hypertension such as restlessness, sweating and sleep disorders. Plasma levels of renin were obtained in 12 of 20 patients. Five patients had raised plasma renin levels. All patients with a severe hypertension were treated with one to several antihypertensive drugs. Risk factors for the development of severe renal hypertension in early infancy are cystic renal malformation, vesico-ureteral reflux, obstructive uropathy and to our experience also short term percutaneous nephrostomy in obstructive uropathy in particular in connection with pyelonephritis. Hypertension can still appear after the successful surgical correction of urinary obstruction. We describe the group of patients with severe hypertension in our study group; diagnostic principles and our therapeutic approach are explained. We conclude that early diagnosis of severe hypertension and consecutive treatment are important in infants with congenital urinary malformations.