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Hydronephrosis and risk of later development of hypertension

Mattias Carlström1

  • 1Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.

Acta Paediatrica (Oslo, Norway : 1992)
|July 1, 2018
PubMed

Insights

Congenital ureteral obstruction in infants may lead to later-life hypertension. Current non-surgical management of hydronephrosis should be reconsidered to prevent elevated blood pressure risks.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Experimental Pathology

Background:

  • Congenital ureteral obstruction is common in infants, with ongoing debate regarding optimal clinical management.
  • The long-term physiological effects of conservative, non-surgical management for asymptomatic hydronephrosis in children remain unclear.

Purpose of the Study:

  • To review current experimental and clinical evidence linking congenital ureteral obstruction to long-term health consequences.
  • To evaluate the association between hydronephrosis and the development of hypertension.
  • To inform clinical practice regarding the management of pediatric hydronephrosis.

Main Methods:

  • Mini-review incorporating experimental studies (rats, mice) and clinical studies (children, adults).
  • Analysis of retrospective and prospective studies on hydronephrosis and blood pressure.
  • Examination of mechanisms underlying hypertension in experimental hydronephrosis models.

Main Results:

  • Experimental models show partial ureteropelvic junction obstruction (UPJO) causally linked to hypertension and renal injury.
  • Mechanisms include renin-angiotensin-aldosterone system activation, increased renal sympathetic nerve activity, oxidative stress, and nitric oxide deficiency.
  • Clinical studies associate hydronephrosis with elevated blood pressure, potentially reduced by surgical intervention.

Conclusions:

  • Current non-operative management of hydronephrosis warrants reconsideration.
  • Revising management strategies may reduce the risk of developing hypertension in later life.
  • Further research is needed to establish optimal long-term care for infants with congenital ureteral obstruction.
Abstract

Keywords:
Blood pressureHydronephrosisHypertensionUreteral obstruction

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