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        "resumen" => "RESUMEN. En el periodo comprendido desde enero de 1986 hasta diciembre del 2004, se recibieron 67 niños y adolescentes por sospecha de padecer hipertensión vasculo-renal (HTA-VR). Los pacientes fueron sometidos a estudios bioquímicos e imagenológicos, pero en todos los casos la arteriografía por sustracción digitálica (ASD) fue determinante para el diagnóstico y la estrategia de tratamiento. Al concluir el estudio, 21 (31.3%) pacientes (Grupo 1) fueron diagnosticados de HTA-VR por estenosis arterial, 14(66.7%) unilateral, 4 (19.0%) bilateral y 3 (14.3%) en rama. En el resto de los 46 (68.7%) pacientes (Grupo 2), no se identificó causa etiológica. Grupo I: promedio de edad 13.9±3.7 años, raza blanca 66%, varones 48%, tiempo de hipertensión conocido 26.4±35.3 meses, tensión arterial máxima referida 191±30.5 mmHg para la sistólica y 135±21 mmHg para la diastólica. Grupo 2: promedio de edad 14.7±3.7 años, raza blanca 67%, varones 74 %, tiempo de hipertensión conocido 24.2±30.19 meses, tensión arterial máxima referida 163±27.7 mmHg para la sistólica y 108±17 mmHg para la diastólica. La etiología mas frecuente de HTA-VR fue la displasia fibromuscular 69% de los casos. Se seleccionaron tres modalidades terapéuticas: 1) angioplastia transluminal percutanea (ATP) que se utilizó en 11 pacientes, 2 combinados con cirugía (1 autotrasplante y 1 nefrectomía posterior a trombosis arterial), con 81.8% de control (curado + mejorado) de la hipertensión con un seguimiento promedio de 11.5 años (1 a 18 años), 2) cirugía (autotrasplante o nefrectomía) en 5 casos, más la nefrectomía post-ATP referida, con cura de la hipertensión en todos ellos y 3) 4 pacientes fueron tratados con hipotensores y diuréticos. En diciembre del 2004, 19/21 (90%) de los pacientes con HTA-VR estaban normotensos con creatinina sérica normal, 10 (48%) curados y 9 (43%) mejorados con algún soporte de hipotensores o diurético), y en 2 (9%) de los pacientes se perdió el seguimiento. Los restantes 46 (68.8%) niños no-HTA-VR tratados, tuvieron adecuado control de la TA con función renal normal. Conclusiones: La pauta de estudio empleada fue útil para el diagnóstico de HTA-VR en nuestro grupo adolescentes hipertensos con signos de clínicos de sospecha de padecer esta entidad. La gammagrafía pre-post captopril fue la prueba más sensible Palabras clave: Hipertensión en adolescentes. Hipertensión vasculo-renal. Angioplastia transluminal percutánea Resultados clínicos, analíticos y estudios imagenológicos en adolescentes Clinical, analytics and imagine studies results in adolescents hypertensive ever a 19 years period. J.P. Alfonzo*, C. Ugarte**, J. Banasco***, R. Fraxedas*, J. González* y J.Lahera** *Instituto de Nefrología ¿Dr. Abelardo Buch López¿. **Centro de Investigaciones Médico-quirúrgicas. ***Hospital Hermanos Ameijeiras. La Habana. Cuba"
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        "resumen" => "SUMMARY Sixty seven hypertensive children age 2-18 with at least one possible clinical sign of renovascular hypertension (RVH) were enrollment into a screening program for diagnose and treatment of RVH over a 19 year period. Patients underwent a variety of biochemical and imaging studies, but in all cases, renal arteriography was used to determine the precise diagnosis and treatment strategy. Of the 67 patients 21 (31.3%) were identified with renal artery stenosis Group 1, 14 (66.6%) unilateral, 5 (23.8%) bilateral and 2 (9.6%) branches. The mean age was 13.9 ± 3.73 years, with 26.4 ± 35.2 months of known hypertension, mean systolic blood pressure 191.1 ± 30.6 mmHg, mean diastolic blood pressure 135.3 ± 21.2 mmHg and 69% due to fibromuscular dysplasia. Three therapeutic modalities were chosen: percutaneous transluminal angioplasty (PTA), surgery (autotransplant, and nephrectomy), pharmaceutical therapy with antihypertensive drugs and combination of these. The aim of the treatment was blood pressure control, prevention of chronic renal disease and renal function and organ damage preservation. The outcome was categorized as cure, improvement or no change in hypertension. PTA treated eleven patients, 2 combined with surgery (one nephrectomy and 1 autotransplant). Blood pressure was normalized in 9/11 (81.8%) after a mean follow-up of 11.5 years (range 1-18 years). All 6 RVH cases treated by surgery procedure (one after PTA) were cured and 4 cases were managed medically (pharmacological treatment). On december 2004, 19/21 (90%) RVH adolescents blood pressure was normalized with normal serum creatinina, 10 (48%) of these completed cured, 9/21 (43%) improved (normotensión with decrease in medication requirements) and 2 (9%) other cases ware lost of follow-up. The 46 non-RVH adolescents (68.7%) were treated with long term antihypertensive medications&#59; all of these have adequate BP control and normal renal function. We conclude that our work-up used in order to make a proper and timely diagnosis and treatment of renovascular hypertension in adolescent was successful in our population. "
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Clinical, analytics and imagine studies results in hypertensive adolescents over a 19 years period
Hipertensión vasculo-renal en niños y adolescentes: diagnóstico y tratamiento durante 19 años
J.P. Alfonzo, C. Ugarte, J. Banasco, R. Fraxedas, F. Gutiérrez, J.Lahera
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        "resumen" => "RESUMEN. En el periodo comprendido desde enero de 1986 hasta diciembre del 2004, se recibieron 67 niños y adolescentes por sospecha de padecer hipertensión vasculo-renal (HTA-VR). Los pacientes fueron sometidos a estudios bioquímicos e imagenológicos, pero en todos los casos la arteriografía por sustracción digitálica (ASD) fue determinante para el diagnóstico y la estrategia de tratamiento. Al concluir el estudio, 21 (31.3%) pacientes (Grupo 1) fueron diagnosticados de HTA-VR por estenosis arterial, 14(66.7%) unilateral, 4 (19.0%) bilateral y 3 (14.3%) en rama. En el resto de los 46 (68.7%) pacientes (Grupo 2), no se identificó causa etiológica. Grupo I: promedio de edad 13.9±3.7 años, raza blanca 66%, varones 48%, tiempo de hipertensión conocido 26.4±35.3 meses, tensión arterial máxima referida 191±30.5 mmHg para la sistólica y 135±21 mmHg para la diastólica. Grupo 2: promedio de edad 14.7±3.7 años, raza blanca 67%, varones 74 %, tiempo de hipertensión conocido 24.2±30.19 meses, tensión arterial máxima referida 163±27.7 mmHg para la sistólica y 108±17 mmHg para la diastólica. La etiología mas frecuente de HTA-VR fue la displasia fibromuscular 69% de los casos. Se seleccionaron tres modalidades terapéuticas: 1) angioplastia transluminal percutanea (ATP) que se utilizó en 11 pacientes, 2 combinados con cirugía (1 autotrasplante y 1 nefrectomía posterior a trombosis arterial), con 81.8% de control (curado + mejorado) de la hipertensión con un seguimiento promedio de 11.5 años (1 a 18 años), 2) cirugía (autotrasplante o nefrectomía) en 5 casos, más la nefrectomía post-ATP referida, con cura de la hipertensión en todos ellos y 3) 4 pacientes fueron tratados con hipotensores y diuréticos. En diciembre del 2004, 19/21 (90%) de los pacientes con HTA-VR estaban normotensos con creatinina sérica normal, 10 (48%) curados y 9 (43%) mejorados con algún soporte de hipotensores o diurético), y en 2 (9%) de los pacientes se perdió el seguimiento. Los restantes 46 (68.8%) niños no-HTA-VR tratados, tuvieron adecuado control de la TA con función renal normal. Conclusiones: La pauta de estudio empleada fue útil para el diagnóstico de HTA-VR en nuestro grupo adolescentes hipertensos con signos de clínicos de sospecha de padecer esta entidad. La gammagrafía pre-post captopril fue la prueba más sensible Palabras clave: Hipertensión en adolescentes. Hipertensión vasculo-renal. Angioplastia transluminal percutánea Resultados clínicos, analíticos y estudios imagenológicos en adolescentes Clinical, analytics and imagine studies results in adolescents hypertensive ever a 19 years period. J.P. Alfonzo*, C. Ugarte**, J. Banasco***, R. Fraxedas*, J. González* y J.Lahera** *Instituto de Nefrología ¿Dr. Abelardo Buch López¿. **Centro de Investigaciones Médico-quirúrgicas. ***Hospital Hermanos Ameijeiras. La Habana. Cuba"
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        "resumen" => "SUMMARY Sixty seven hypertensive children age 2-18 with at least one possible clinical sign of renovascular hypertension (RVH) were enrollment into a screening program for diagnose and treatment of RVH over a 19 year period. Patients underwent a variety of biochemical and imaging studies, but in all cases, renal arteriography was used to determine the precise diagnosis and treatment strategy. Of the 67 patients 21 (31.3%) were identified with renal artery stenosis Group 1, 14 (66.6%) unilateral, 5 (23.8%) bilateral and 2 (9.6%) branches. The mean age was 13.9 ± 3.73 years, with 26.4 ± 35.2 months of known hypertension, mean systolic blood pressure 191.1 ± 30.6 mmHg, mean diastolic blood pressure 135.3 ± 21.2 mmHg and 69% due to fibromuscular dysplasia. Three therapeutic modalities were chosen: percutaneous transluminal angioplasty (PTA), surgery (autotransplant, and nephrectomy), pharmaceutical therapy with antihypertensive drugs and combination of these. The aim of the treatment was blood pressure control, prevention of chronic renal disease and renal function and organ damage preservation. The outcome was categorized as cure, improvement or no change in hypertension. PTA treated eleven patients, 2 combined with surgery (one nephrectomy and 1 autotransplant). Blood pressure was normalized in 9/11 (81.8%) after a mean follow-up of 11.5 years (range 1-18 years). All 6 RVH cases treated by surgery procedure (one after PTA) were cured and 4 cases were managed medically (pharmacological treatment). On december 2004, 19/21 (90%) RVH adolescents blood pressure was normalized with normal serum creatinina, 10 (48%) of these completed cured, 9/21 (43%) improved (normotensión with decrease in medication requirements) and 2 (9%) other cases ware lost of follow-up. The 46 non-RVH adolescents (68.7%) were treated with long term antihypertensive medications&#59; all of these have adequate BP control and normal renal function. We conclude that our work-up used in order to make a proper and timely diagnosis and treatment of renovascular hypertension in adolescent was successful in our population. "
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ISSN: 20132514
Original language: English
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