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Involvement of the central nervous system in renal hypertension
K Schärer1, C Benninger, A Heimann
1Division of Paediatric Nephrology, University Children's Hospital, Heidelberg, Germany.
Insights
Central nervous system (CNS) complications in children with renal hypertension are common, especially with advanced renal failure. Early blood pressure monitoring in renal disease is crucial to prevent severe neurological outcomes.
Area of Science:
- Pediatric Nephrology
- Neurology
- Hypertension Research
Background:
- Central nervous system (CNS) involvement is a significant complication of renal hypertension.
- Hypertensive encephalopathy is a common cause of CNS manifestations in renal hypertension.
- Children with renal hypertension present with diverse neurological symptoms.
Purpose of the Study:
- To investigate the association between renal hypertension and CNS manifestations in children.
- To compare CNS symptoms in children with and without advanced renal failure.
- To evaluate mortality rates and identify risk factors.
Main Methods:
- A 17-year observational study of 58 children with renal hypertension and CNS manifestations.
- Patients were divided into two groups: without (Group A) and with (Group B) advanced renal failure.
- Clinical data, symptoms, and outcomes were analyzed.
Main Results:
- Convulsions were the most frequent symptom (65%), followed by reduced consciousness (69%) and visual disturbances (28%).
- Hypertension was diagnosed after CNS symptoms appeared in 56% of Group A patients.
- Mortality was higher in Group B (19 deaths) compared to Group A (3 deaths), with intracranial hemorrhage noted in 3 cases.
Conclusions:
- Renal hypertension poses a significant risk for CNS complications in children.
- Improved therapies reduced mortality in children with advanced renal failure, but not in those without.
- Frequent blood pressure monitoring is essential for children with acute or chronic renal disease.
Abstract:
Involvement of the central nervous system (CNS) is a major complication of renal hypertension and is usually due to hypertensive encephalopathy. During a 17-year period we observed 25 children with renal hypertension associated with CNS manifestations in the absence of (group A) and 33 in the presence of advanced renal failure (group B). Convulsions were the most important symptom (65% in both groups combined). Other manifestations were reduced consciousness (69%), visual disturbances (28%), hemiplegia (14%), and cranial nerve palsy (10%). In 56% of children in group A, hypertension was recognised only after appearance of CNS symptoms. Three patients in group A and 19 in group B died. Intracranial haemorrhage associated with hemiplegia was found in 3 cases. From 1970-1977 to 1978-1986 the number of patients and the mortality in group B declined dramatically, probably as a result of improved antihypertensive and renal replacement therapy. In contrast, in group A the number of patients and of CNS symptoms remained similar. The study underlines the importance of frequent blood pressure monitoring in presence of acute or chronic renal disease.