Related Experiment Videos
Management of children with hypertension from reflux or obstructive nephropathy
V Braren1, J C West, R C Boerth
1Department of Urology, Vanderbilt University School of Medicine, Nashville, Tennessee.
Insights
Children with vesicoureteral reflux or ureteropelvic junction obstruction require regular blood pressure monitoring. Hypertension can develop years after treatment, even with previous normal readings.
Area of Science:
- Pediatric Nephrology
- Pediatric Urology
Background:
- Hypertension in children can be associated with congenital urinary tract anomalies.
- Vesicoureteral reflux (VUR) and ureteropelvic junction (UPJ) obstruction are common pediatric uropathies.
- The long-term sequelae of these conditions, including hypertension, require ongoing investigation.
Purpose of the Study:
- To investigate the incidence and characteristics of hypertension in children with VUR, UPJ obstruction, or small kidneys.
- To evaluate the effectiveness of surgical intervention for hypertension in this cohort.
- To establish recommendations for long-term blood pressure monitoring.
Main Methods:
- Retrospective review of 35 hypertensive children over a ten-year period with VUR, UPJ obstruction, or small kidneys.
- Analysis of surgical outcomes for hypertension in 15 patients.
- Correlation of hypertension severity with reflux or obstruction degree and calicectasis.
Main Results:
- Thirty-five children with VUR, UPJ obstruction, or small kidneys were identified as hypertensive.
- Seven of 15 surgically treated patients were cured of hypertension; six improved.
- Hypertension severity did not correlate with reflux or obstruction grade, but calicectasis was noted in reflux patients.
- Hypertension can manifest years post-successful anti-reflux surgery.
Conclusions:
- Children diagnosed with VUR, UPJ obstruction, or small kidneys are at risk for developing hypertension.
- Regular blood pressure monitoring is crucial, regardless of previous readings or surgical status.
- Recommended monitoring includes quarterly checks for the first year post-diagnosis, then annually.
Abstract:
During a ten-year period, 35 children presenting with vesicoureteral reflux, ureteropelvic junction obstruction, or a "small kidney" were found to be hypertensive. Of these, 15 subsequently underwent surgical procedures for relief of hypertension. Seven were "cured," six were "improved," and two were "unchanged." The severity of hypertension could not be correlated with the degree of reflux nor with the degree of obstructive uropathy. However, all children with reflux in our study who were hypertensive had some degree of calicectasis noted preoperatively on intravenous pyelogram. Also it was noted that hypertension may occur several years after successful anti-reflux surgery. Children with vesicoureteral reflux, ureteropelvic junction obstruction, or a small kidney need to have blood pressure determinations at regular intervals, even if all previous readings had been in the normotensive range and whether or not they were followed up medically or post surgically. We suggest that blood pressure determinations be made every three months for the first year after diagnosis of reflux or ureteropelvic junction obstruction, and at least once a year thereafter.