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Long-term follow-up of neonatal renovascular hypertension
1Pediatric Nephrology, University of California, Davis, School of Medicine 95616.
Insights
Neonatal hypertension often results from renal artery thrombosis linked to umbilical artery catheters. Most infants achieve normal blood pressure with medical treatment, though renal abnormalities may persist.
Area of Science:
- Pediatric Nephrology
- Neonatal Medicine
- Cardiovascular Research
Background:
- Neonatal hypertension is a critical condition requiring thorough investigation.
- Umbilical artery catheterization is a common neonatal procedure with potential complications.
- Renovascular disease is a significant cause of secondary hypertension in infants.
Purpose of the Study:
- To investigate the long-term outcomes of neonatal hypertension.
- To identify the causes and associated factors of renovascular hypertension in neonates.
- To evaluate the efficacy of medical management for neonatal hypertension.
Main Methods:
- Longitudinal follow-up of twelve neonates diagnosed with hypertension.
- Assessment of blood pressure, renal function (creatinine clearance, urinalysis), and plasma renin activity.
- Diagnostic imaging including radionuclide renal scans and angiography to identify renovascular disease.
- Evaluation of umbilical artery catheterization history and placement.
Main Results:
- Renovascular disease, primarily renal artery thrombosis, was identified in 11 out of 12 neonates.
- Hypertension was frequently associated with umbilical artery catheterization, with 9/10 catheters placed above renal arteries.
- All infants achieved normalized blood pressure with medical therapy, which was sustained after discontinuation.
- Despite normalized blood pressure, 5/11 infants showed unilateral renal atrophy, and radionuclide scans remained abnormal.
Conclusions:
- Neonatal renovascular hypertension is often secondary to renal artery thrombosis, linked to umbilical artery catheterization.
- Conservative medical management is effective in normalizing blood pressure in affected neonates.
- Persistent renal abnormalities, including atrophy and abnormal imaging findings, are common despite successful blood pressure control.
Abstract:
Twelve neonates with hypertension have been followed for a mean of 5.75 years. At onset of hypertension, mean peak blood pressure was 159/99 mm Hg. Ten infants had umbilical artery catheters, 9 placed above the origin of the renal arteries. Radionuclide renal scan and/or angiography demonstrated renovascular disease, primarily renal artery thrombosis, in 11 infants. One-third of infants were asymptomatic, one-third had normal urinalyses and two-thirds had elevated peripheral plasma renin activities. Blood pressure normalized with medical therapy in all infants and remained normal when therapy was discontinued. Ten infants have normal creatinine clearances on follow-up but 5/11 have unilateral renal atrophy. Radionuclide scans have remained abnormal, even in infants without renal atrophy. In summary, neonatal renovascular hypertension is frequently secondary to renal artery thrombosis, associated with umbilical artery catheterization. Blood pressure usually normalizes with conservative medical management and remains normal off medications. Persistent abnormalities in renal size and function are common.