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Potential impact of severe hydronephrosis secondary to ureteropelvic junction obstruction on pediatric blood pressure
Qingqing Tian1, Chu Zhang1, Xiang Zhao1
1Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Hydronephrosis in children can elevate blood pressure (BP) and affect the renin-angiotensin-aldosterone system (RAAS). Pyeloplasty surgery significantly reduces BP in these pediatric patients.
Area of Science:
- Pediatric Nephrology
- Pediatric Urology
- Cardiovascular Physiology
Background:
- Hydronephrosis, particularly from ureteropelvic junction obstruction (UPJO), may impact pediatric blood pressure (BP), a factor often underestimated in children.
- Children possess distinct physiological characteristics, including lower baseline BP, greater vascular elasticity, and enhanced hypertension resistance compared to adults.
Purpose of the Study:
- To prospectively investigate the effects of hydronephrosis secondary to UPJO on pediatric blood pressure.
- To examine the association between hydronephrosis, pediatric BP, and the renin-angiotensin-aldosterone system (RAAS).
Main Methods:
- 114 children with severe hydronephrosis secondary to UPJO were categorized into five age groups and compared to 153 controls.
- Preoperative and postoperative systolic BP (SBP), diastolic BP (DBP), active renin concentration (ARC), and aldosterone concentration (AC) were measured.
- The study analyzed the impact of severe UPJO-related hydronephrosis on pediatric BP and its correlation with RAAS components.
Main Results:
- Children with hydronephrosis exhibited higher SBP, DBP, ARC, and AC compared to controls, with variations across age groups.
- Post-pyeloplasty, BP in the hydronephrosis group normalized to control levels, while ARC decreased significantly but remained elevated compared to controls.
- A positive correlation was observed between the change in DBP and the change in AC following pyeloplasty.
Conclusions:
- Severe pediatric hydronephrosis secondary to UPJO is associated with elevated BP, ARC, and AC.
- Pyeloplasty effectively reduces BP in affected children.
- The link between elevated BP and the RAAS in pediatric hydronephrosis warrants further in-depth research.
Background:
Hydronephrosis could affect blood pressure (BP) according to published case reports and animal experiments. The impact on pediatric BP is often overlooked due to children's inherently lower BP, superior vascular elasticity and greater resistance to hypertension than adults.
Objective:
This study aimed to prospectively observe the effects of hydronephrosis, secondary to ureteropelvic junction obstruction (UPJO), on pediatric BP.
Methods:
Children with hydronephrosis secondary to UPJO who required pyeloplasty were categorized into five age groups: neonates, infants, toddlers, preschoolers, and school-aged children. Preoperative and postoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), active renin concentration (ARC), and aldosterone concentration (AC) were compared among these age groups, followed by comparison with a control group of children without nephritis or cardiovascular conditions. The impact of severe hydronephrosis secondary to UPJO on pediatric BP and its association with the renin-angiotensin-aldosterone system (RAAS) were examined.
Results:
This study enrolled 114 children with severe hydronephrosis secondary to UPJO and 153 without nephritic or cardiovascular conditions between September 2021 and June 2023. As the control group aged, SBP and DBP increased, whereas ARC and AC decreased. Overall, hydronephrosis group had higher SBP, DBP, ARC, and AC than the controls group. These differences differed between the age groups. After pyeloplasty, the postoperative BP of hydronephrosis group approximated that of the control group. Postoperative ARC levels were higher than those in the control group but were much lower than the preoperative levels. AC did not decrease significantly after surgery. The change in DBP in children with hydronephrosis before and after pyeloplasty showed a positive correlation with the change in AC.
Conclusions:
Pediatric patients with severe hydronephrosis, a condition secondary to UPJO, displayed elevated BP, ARC, and AC. Following pyeloplasty, these patients noted a reduction in BP. The correlation between elevated blood pressure and the RAAS necessitates further comprehensive investigation.
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