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Hypertension III: Clinical Manifestations and Diagnostic Studies01:30

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Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...
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Hypertension is a chronic condition in which the blood's force against artery walls is excessively high, posing risks such as heart disease. The condition's underlying mechanisms involve complex interactions among the cardiovascular, kidney, and autonomic nervous systems.Renin-Angiotensin-Aldosterone System (RAAS): This system significantly influences blood pressure regulation. When blood pressure decreases, the kidneys secrete renin. This enzyme transforms angiotensinogen, a plasma protein,...
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Hypertension and a missing kidney.

Rupesh Raina1, Vikas Gulani2, Lina Mehta2

  • 1Division of Pediatric Nephrology, Department of Pediatrics , University Hospitals of Cleveland , Cleveland OH , USA.

Clinical Kidney Journal
|April 16, 2015
PubMed
Summary
This summary is machine-generated.

A malformed kidney in the chest caused hypertension in a young girl. Surgical removal of this ectopic kidney successfully normalized her blood pressure, highlighting a rare cause of pediatric hypertension.

Keywords:
congenital anomalyectopic kidneyhypertensionrenovascular

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Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Physiology
  • Medical Imaging

Background:

  • Hypertension in children can stem from various underlying conditions.
  • Ectopic kidneys, particularly those in unusual locations like the chest, are rare congenital anomalies.
  • The renin-angiotensin-aldosterone system is a key regulator of blood pressure.

Purpose of the Study:

  • To investigate the cause of hypertension in a 4-year-old girl with a missing kidney.
  • To determine the role of an ectopic, malformed kidney in pediatric hypertension.
  • To evaluate treatment strategies for hypertension caused by a malformed ectopic kidney.

Main Methods:

  • Initial assessment included ultrasound and functional nuclear imaging.
  • Blood pressure was monitored before and after surgical intervention.
  • Histopathological examination of the removed kidney was performed.
  • Literature review on similar cases and treatment approaches.

Main Results:

  • Ultrasound revealed the absence of a kidney in the typical location.
  • Nuclear imaging identified a malformed kidney within the chest (intrathoracic kidney).
  • Systemic renin and aldosterone levels were not elevated.
  • Nephrectomy (surgical removal of the kidney) resolved the hypertension.
  • The malformed kidney showed smooth muscle nodules around its arteries.

Conclusions:

  • A malformed intrathoracic kidney can cause significant hypertension in children, even without elevated systemic hormonal markers.
  • Surgical removal is an effective treatment for hypertension secondary to such ectopic renal anomalies.
  • Pharmacological attempts to reduce renal blood flow were unsuccessful, supporting surgical intervention.