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Fetal and infantile hypertension caused by unilateral renal arterial disease
D I Wilson1, R E Appleton, M G Coulthard
1Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne.
Insights
Unilateral renal arterial disease can cause severe infant hypertension and heart failure. Unilateral nephrectomy effectively cured hypertension in three infants, highlighting the importance of blood pressure monitoring in failing to thrive children.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Vascular Disease
Background:
- Infantile heart failure can stem from severe hypertension.
- Unilateral renal arterial disease is a potential cause of this hypertension.
- Early diagnosis and intervention are crucial for affected infants.
Observation:
- Three infants presented with heart failure due to severe hypertension linked to unilateral renal arterial disease.
- One infant exhibited signs of long-standing fetal hypertension, a previously undescribed presentation.
- Two infants presented with failure to thrive due to undiagnosed hypertension.
Findings:
- All three infants underwent successful unilateral nephrectomy, which resolved their hypertension.
- Post-nephrectomy, all children thrived, demonstrating the procedure's efficacy.
- The benefits of nephrectomy, including hypertension cure and improved well-being, surpassed the risks of surgery and renal function loss.
Implications:
- Unilateral nephrectomy is a viable and beneficial treatment for hypertension caused by unilateral renal arterial disease in infants.
- Routine blood pressure measurement in children failing to thrive is essential for early detection of underlying conditions like hypertension.
- This study underscores the importance of considering renal vascular causes in pediatric hypertension presenting with heart failure.
Abstract:
Three children who presented with heart failure in infancy caused by severe hypertension as a result of unilateral renal arterial disease are described. One presented at 3 days of age with persistent fetal circulation and heart failure. He had abnormal great vessels that indicated that the hypertension was of long standing and therefore fetal; this has not been described previously. The other two children failed to thrive because of unrecognised hypertension and subsequently presented with heart failure. All three underwent unilateral nephrectomy which cured their hypertension, and all were thriving at the time of writing. The benefits of nephrectomy outweighed the operative risks and loss of renal function. Blood pressure should be measured in children who are failing to thrive as part of routine clinical practice.