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Impaired weight gain and renovascular hypertension
Insights
Severe hypertension in an infant due to renal artery stenosis was successfully treated with microsurgical reconstruction. This intervention improved blood pressure and weight gain, highlighting the importance of monitoring blood pressure in all hospitalized children.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery
- Pediatric Endocrinology
Background:
- Infants with poor weight gain require thorough medical evaluation.
- Unexplained hypertension in children can indicate underlying renal pathology.
- Early detection and treatment of renovascular hypertension are crucial for long-term outcomes.
Observation:
- An eight-month-old infant presented with poor weight gain, progressing to unconsciousness and convulsions.
- Severe hypertension (205/120 mm Hg) was noted during hospitalization.
- Elevated plasma renin activity and serum aldosterone levels suggested a renovascular cause.
Findings:
- Renal angiography revealed significant stenosis of the left renal artery.
- Microsurgical reconstruction of the renal artery was performed.
- Post-operatively, the child showed significant improvement in blood pressure and weight percentile.
Implications:
- This case underscores the necessity of routine blood pressure monitoring in all hospitalized infants and children, irrespective of presenting symptoms.
- Microsurgical repair of renal artery stenosis can be an effective treatment for pediatric renovascular hypertension.
- Addressing renovascular hypertension can lead to substantial improvements in growth and overall health in affected children.
Abstract:
An eight month old infant was admitted to hospital because of poor weight gain. During the hospitalization she became unconscious and had convulsions. On these occasions a high blood pressure (205/120 mm Hg) was measured. In further evaluation of the hypertension, high plasma renin activity (32.8 ug/l/h) with a high serum aldosterone concentration (13000 pmol/l) was measured. Because of these findings renal angiography was performed: this revealed a stenosis of the left renal artery. A reconstruction of the renal artery was performed by a microsurgical technique and nine months after the operation the child was only mildly hypertensive but still required antihypertensive medication (propranolol 10 x 3, hydralazine 5 mg x 2): with this treatment her blood pressure was 110/80 mm Hg. After the operation her weight rose from below 2.5 percentile to the 10th percentile. The importance of blood pressure measurement in all children and infants admitted to hospital, regardless of their symptoms, is stressed.