Assuntos
Pielonefrite/diagnóstico por imagem , Infecções Urinárias/diagnóstico por imagem , Criança , Humanos , Córtex Renal/diagnóstico por imagem , Pielonefrite/diagnóstico , Pielonefrite/etiologia , Radiografia , Cintilografia , Sensibilidade e Especificidade , Bexiga Urinária/diagnóstico por imagem , Refluxo Vesicoureteral/complicaçõesRESUMO
Fifteen children with renovascular hypertension as a result of aortic thrombosis were followed for a mean of 26 months (range 5 to 58 months) to determine outcome. As neonates, all patients had hypertension and elevated plasma renin activity. Of 11 patients studied with radionuclide renography and scintigraphy, 10 had abnormal renal blood flow; three had complete absence of unilateral perfusion. On follow-up examination all children were normotensive; five children ages 5 to 24 months required antihypertensive medication. Of 15 children, 14 had normal statural growth; all had normal serum creatinine, plasma renin activity, and calculated glomerular filtration rate values. Patients with complete absence of renal perfusion unilaterally remained functionally anephric; children with less severe perfusion deficits had improved perfusion as shown by radionuclide renography and scintigraphy. We believe that many patients with aortic thrombosis and renovascular hypertension who have had aggressive antihypertensive therapy in the neonatal period will have good renal function and increased perfusion to the affected kidney 2 years later.
Assuntos
Doenças da Aorta/fisiopatologia , Hipertensão Renovascular/fisiopatologia , Trombose/fisiopatologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etiologia , Cateterismo Periférico/efeitos adversos , Creatinina/sangue , Seguimentos , Taxa de Filtração Glomerular , Humanos , Hipertensão Renovascular/diagnóstico , Hipertensão Renovascular/etiologia , Recém-Nascido , Prognóstico , Estudos Prospectivos , Cintilografia , Renina/sangue , Trombose/diagnóstico por imagem , Trombose/etiologia , Ultrassonografia , Artérias UmbilicaisRESUMO
Renal function was studied in 74 subjects who, between 1966 and 1972 (ages 1 to 6 years) had had blood lead levels (PbB) greater than or equal to 100 micrograms/dl (range 100 to 471 micrograms/dl, median 142 micrograms/dl) and in 21 sibling controls. PbB measured in 1983 in study subjects remained significantly higher than in sibling controls (mean +/- 1 SD 14.5 +/- 4.5 vs 11.6 +/- 2.6 micrograms/dl, P less than 0.01). The two groups did not differ in development of hematuria or leukocyturia. The frequency of elevated serum creatinine concentration, depressed creatinine clearance, elevated protein excretion, low urinary osmolality, elevated serum beta 2-microglobulin (beta 2-M), and elevated fractional excretion beta 2-M % X 100 was similar in the two groups. Mean values for these tests were similar in study subjects compared with sibling controls. Mean systolic blood pressure was significantly higher in study subjects compared with that in sibling controls (117 +/- 12 vs 109 +/- 10 mm Hg), but the control group contained a preponderance of females and the study group had more overweight females; mean diastolic blood pressure was similar in the two groups. We conclude that in our adolescent subjects who had had lead poisoning 9 to 17 years earlier, there is little if any evidence of chronic nephropathy.