Reno-ureteral diseases inducing hypertension in children.
Revealing the cause of renal hypertension is a major objective in medical practice. A series of investigations are required in order to elucidate the primary disease and then the treatment surgical and/or medical. The transitory hypertension of adolescent is not discussed in this paper. Measuring the blood pressure in children is often neglected and the evaluation of the hypertension is performed after the diagnosis of the renovascular disease. The classification of renovascular hypertension in children and the statistical evaluation of its etiology in order to reveal the most frequent renovascular disease are a topical work of several authors. A guide of the most frequent causes of hypertension in children edited after the studies of several authors may lead to a complete classification and describe a complexed concept regarding diagnosis, evaluation and treatment of the patients. This paper displays an analytic study on 19 patients, aged between 2 and 15 years, diagnosed with hypertension and presenting signs and symptoms of hypertension. Four of the 19 patients needed medical treatment, 12, surgical treatment, and for three patients the treatment was mixed. The renal hypertension was determined by aberrant renal arteries in four cases, by pyelonephritis in four cases, by reno-pyeloureteral duplication with congenital megaureter in two cases and by transversal renal rupture, renal agenesis, horse shoe kidney, glomerulonephritis and Wilms tumor, in one case each. In our study, the parenchymal diseases predominated (12 cases of 19-63.1%) over the 7 cases with renovascular lesions--36.9%. Among the parenchymal diseases seven are unilateral, six reno-ureteral malformations and a pyelonephritis, and five are bilateral, four pyelonephritis and a glomerulonephritis.Those seven cases of renovascular lesions include six indirect lesions (three hydronephrosis, one Wilms tumor, one renal abscess, one renal trauma) and one case of congenital vascular anomaly without stenosis (renal agenesis). All reno-ureteral diseases included in Ursea-Ionescu-Târgovişte classification can induce hypertension but renovascular hypertension does not appear in all cases. The diagnosis of the reno-ureteral diseases inducing hypertension in children permits the treatment of hypertension and reno-ureteral illness. The analytic study of diagnostic and treatment methods of different diseases and authors may select the most efficient methods and orientate towards a new therapeutical concept and/or evaluation system. The treatment of the reno-ureteral diseases inducing hypertension avoids the development of some serious complications: the retinopathy, the chronic renal failure, the cerebrovascular accidents.