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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#58;</p><p class="elsevierStylePara">Tuberous sclerosis &#40;TS&#41; is a congenital anomaly of embryonic development&#44; autosomal dominant inherited disorder&#44; which has different forms of clinical expression&#46; It is classified among the so-called phacomatoses&#58; developmental anomalies susceptible to generating tumours or hamartomas of the nervous system&#46; We present the case of a patient who was diagnosed by chance after a consultation in the Emergency Unit for another reason&#46;</p><p class="elsevierStylePara">The case concerns a schoolgirl of 6 years and 6&#47;12 months who attended the Emergency Unit due to an evanescent&#44; occasionally petequial&#44; rash which had been developing for several hours&#46; Associated fever&#46; Examination&#58; weight 15&#46;300kg &#40;SD 6&#46;3kg&#41;&#46; Height 100cm &#40;SD 16cm&#41;&#46; Blood pressure&#58; MID-160&#47;120&#44; MII-177&#47;107&#44; MSI- 169&#47;118&#44; MSD-169&#47;110&#46;</p><p class="elsevierStylePara">On physical examination the child showed no indication of severe illness&#46; Afebrile&#46; Dry skin&#44; mucous membranes hydrated and somewhat pale&#46; Dermal lesions associated with acute virosis&#46; Rhythmic heart tones and strong II&#47;VI systolic murmur heard in all positions&#46; No findings in the abdomen&#58; soft&#44; depressible without pain&#44; no organomegaly&#44; sparse adipose tissue&#46; Femoral pulse palpated&#46; DTRs present&#46; No meningeal signs&#46; Hyperemic oropharynx&#46;</p><p class="elsevierStylePara">Additional explorations&#58; CBC&#58; normochromic&#44; normocytic anaemia&#46; Leukocytosis&#44; slight netrophilia&#44; eosinophilia&#46; Biochemistry&#58; glucose 121mg&#47;dL&#44; urea&#58; 135mg&#47;dL&#44; creatinine&#58; 1&#46;6mg&#47;dL&#46; Control&#58; glucose&#58; 81mg&#47;dL&#44; urea&#58; 113mg&#47;dL&#44; creatinine&#58; 1&#46;1mg&#47;dL&#44; magnesium&#58; 2&#46;2&#44; CRP&#58; 215&#46;8mg&#47;l &#40;N&#58; 2-5&#41;&#46; Control&#58; 11&#46;4&#44; ABB&#58; normal&#59; serum iron&#58; 64mg&#47;dL &#40;N&#58; 45-156&#41;&#59; lipid profile&#58; normal&#59; ESR&#58; 4mm &#40;N&#58; 0-20&#41;&#59; PTH&#58; 75U&#47;mcrl&#59; infectious mononucleosis serology negative&#59; pharyngeal culture&#58; Streptococcus pyogenes&#59; aldosterone&#58; 50&#46;10NG&#47;dl&#44; renin&#58; 0&#46;50ngml&#47;h aldosterone&#47;renin&#58; 100&#46;2 &#40;&#60;30&#41;&#46; Coagulation test&#58; normal&#46; Urine&#58; haematuria&#44; mild proteinuria&#46; Renal function test&#58; glomerular filtration&#58; 34ml&#47;min&#47;1&#46;73m2&#59; calciuria&#58; 3mg&#47;kg&#47;day&#59; phosphaturia&#58; 29mg&#47;kg&#47;day &#40;N &#61; 15-20&#41;&#59; natriuria&#58; 3&#46;44mEq&#47;kg&#47;day &#40;3&#46;87 &#177; 1&#46;3mEq&#47;kg&#47;day&#41;&#59; kaliuria&#58; 2&#46;24 mEq&#47;kg&#47;day &#40;1&#46;73 &#177; 0&#46;7mEq&#47;kg&#47;day&#41;&#46; RTP&#58; 64&#37;&#59; urine culture&#58; negative&#59; microalbunin&#47;creatinine index&#58; 3&#46; 222mg&#47;g&#59; folic acid&#44; vitamin B12 and eye depth&#58; papillary pallor&#46; No oedema of the papilla&#44; clear edges&#46; No other abnormalities were found&#59; ECG&#58; left ventricular hypertrophy&#46; Echocardiogram&#58; normal&#59; left hand and wrist x-ray&#58; osseous age of five years&#59; immunoglobulins&#44; C3 and C4 ANA and AMAnormal&#59; catecholamine&#58; normal&#46;</p><p class="elsevierStylePara">Renal abdominal ultrasound &#40;Doppler&#41;&#58; kidneys were within normal size range but with structural alterations&#46; Focal lesions of bilateral renal parenchyma were present&#46;</p><p class="elsevierStylePara">MRI of the abdomen&#44; cranium and pelvis&#58; angiomyolipomas with a sparse or almost undetectable quantity of intratumoral fatty tissue&#46; Cerebral images compatible with small hamartomata in the white matter&#46; Both suggestive of tuberous sclerosis&#46; Genetic tests on TSC1 and TSC2 were both negative&#46;</p><p class="elsevierStylePara">Evolution&#58; improvement in blood pressure after starting treatment with ACEI and ARA II&#44; being normal for the patient&#8217;s age and size after use and with negative proteinuria&#46;</p><p class="elsevierStylePara">Angiomyolipoma &#40;AML&#41; is the most common renal lesion in TS &#40;34-80&#37;&#41;&#44; followed by renal cysts and polycystic disease&#46; This is due to the fact that the TSC2 locus is adjacent to one of the polycystic kidney disease genes &#40;PKD1&#41; and adjacent deletions can produce both phenotypes&#46;</p><p class="elsevierStylePara">Angiomyolipoma is a benign tumour of the renal cortex&#44; characterised by the presence of mature or immature fatty tissue&#44; vascular wall and smooth muscle though with the capacity to provoke severe haemorrhage&#44; replacement of renal parenchyma and mass effect&#44; which can induce pain and may compromise renal function&#46;<span class="elsevierStyleSup">1</span> Renal failure is less frequent&#44; and is generally associated with glomerulosclerosis secondary to hyperfiltration as a result of surgery or tumoral invasion&#44; particularly by cysts&#46;<span class="elsevierStyleSup">2</span> Some patient groups have indicated that there are variants of angiomyolipoma which have the capacity for metastatic growth&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">Despite being benign there is a possibility of malignant transformation&#46;<span class="elsevierStyleSup">4</span> Furthermore&#44; the tumour can occasionally relapse in patients who have already been subject to intervention&#46;<br></br></p>"
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Hypertensive urgency and stunting. What is the diagnosis?
URGENCIA HIPERTENSIVA Y TALLA BAJA. ¿CUÁL ES SU DIAGNÓSTICO?
Elena Perez Gonzaleza, MT. Vargas de los Monterosb, Ana Sanchez Morenoc
a Servicio de Pediatria. Seccion de Nefrologia Pediatrica, Hospital Virgen Macarena, Sevilla, Sevilla, España,
b Servicio de Genetica Clinica, HOspital UNiversitario VirgenMacarena, Sevilla, Sevilla, España,
c Hospital Infantil, Hospital Universitario VirgenMacarena, Sevilla, Sevilla, España,
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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#58;</p><p class="elsevierStylePara">Tuberous sclerosis &#40;TS&#41; is a congenital anomaly of embryonic development&#44; autosomal dominant inherited disorder&#44; which has different forms of clinical expression&#46; It is classified among the so-called phacomatoses&#58; developmental anomalies susceptible to generating tumours or hamartomas of the nervous system&#46; We present the case of a patient who was diagnosed by chance after a consultation in the Emergency Unit for another reason&#46;</p><p class="elsevierStylePara">The case concerns a schoolgirl of 6 years and 6&#47;12 months who attended the Emergency Unit due to an evanescent&#44; occasionally petequial&#44; rash which had been developing for several hours&#46; Associated fever&#46; Examination&#58; weight 15&#46;300kg &#40;SD 6&#46;3kg&#41;&#46; Height 100cm &#40;SD 16cm&#41;&#46; Blood pressure&#58; MID-160&#47;120&#44; MII-177&#47;107&#44; MSI- 169&#47;118&#44; MSD-169&#47;110&#46;</p><p class="elsevierStylePara">On physical examination the child showed no indication of severe illness&#46; Afebrile&#46; Dry skin&#44; mucous membranes hydrated and somewhat pale&#46; Dermal lesions associated with acute virosis&#46; Rhythmic heart tones and strong II&#47;VI systolic murmur heard in all positions&#46; No findings in the abdomen&#58; soft&#44; depressible without pain&#44; no organomegaly&#44; sparse adipose tissue&#46; Femoral pulse palpated&#46; DTRs present&#46; No meningeal signs&#46; Hyperemic oropharynx&#46;</p><p class="elsevierStylePara">Additional explorations&#58; CBC&#58; normochromic&#44; normocytic anaemia&#46; Leukocytosis&#44; slight netrophilia&#44; eosinophilia&#46; Biochemistry&#58; glucose 121mg&#47;dL&#44; urea&#58; 135mg&#47;dL&#44; creatinine&#58; 1&#46;6mg&#47;dL&#46; Control&#58; glucose&#58; 81mg&#47;dL&#44; urea&#58; 113mg&#47;dL&#44; creatinine&#58; 1&#46;1mg&#47;dL&#44; magnesium&#58; 2&#46;2&#44; CRP&#58; 215&#46;8mg&#47;l &#40;N&#58; 2-5&#41;&#46; Control&#58; 11&#46;4&#44; ABB&#58; normal&#59; serum iron&#58; 64mg&#47;dL &#40;N&#58; 45-156&#41;&#59; lipid profile&#58; normal&#59; ESR&#58; 4mm &#40;N&#58; 0-20&#41;&#59; PTH&#58; 75U&#47;mcrl&#59; infectious mononucleosis serology negative&#59; pharyngeal culture&#58; Streptococcus pyogenes&#59; aldosterone&#58; 50&#46;10NG&#47;dl&#44; renin&#58; 0&#46;50ngml&#47;h aldosterone&#47;renin&#58; 100&#46;2 &#40;&#60;30&#41;&#46; Coagulation test&#58; normal&#46; Urine&#58; haematuria&#44; mild proteinuria&#46; Renal function test&#58; glomerular filtration&#58; 34ml&#47;min&#47;1&#46;73m2&#59; calciuria&#58; 3mg&#47;kg&#47;day&#59; phosphaturia&#58; 29mg&#47;kg&#47;day &#40;N &#61; 15-20&#41;&#59; natriuria&#58; 3&#46;44mEq&#47;kg&#47;day &#40;3&#46;87 &#177; 1&#46;3mEq&#47;kg&#47;day&#41;&#59; kaliuria&#58; 2&#46;24 mEq&#47;kg&#47;day &#40;1&#46;73 &#177; 0&#46;7mEq&#47;kg&#47;day&#41;&#46; RTP&#58; 64&#37;&#59; urine culture&#58; negative&#59; microalbunin&#47;creatinine index&#58; 3&#46; 222mg&#47;g&#59; folic acid&#44; vitamin B12 and eye depth&#58; papillary pallor&#46; No oedema of the papilla&#44; clear edges&#46; No other abnormalities were found&#59; ECG&#58; left ventricular hypertrophy&#46; Echocardiogram&#58; normal&#59; left hand and wrist x-ray&#58; osseous age of five years&#59; immunoglobulins&#44; C3 and C4 ANA and AMAnormal&#59; catecholamine&#58; normal&#46;</p><p class="elsevierStylePara">Renal abdominal ultrasound &#40;Doppler&#41;&#58; kidneys were within normal size range but with structural alterations&#46; Focal lesions of bilateral renal parenchyma were present&#46;</p><p class="elsevierStylePara">MRI of the abdomen&#44; cranium and pelvis&#58; angiomyolipomas with a sparse or almost undetectable quantity of intratumoral fatty tissue&#46; Cerebral images compatible with small hamartomata in the white matter&#46; Both suggestive of tuberous sclerosis&#46; Genetic tests on TSC1 and TSC2 were both negative&#46;</p><p class="elsevierStylePara">Evolution&#58; improvement in blood pressure after starting treatment with ACEI and ARA II&#44; being normal for the patient&#8217;s age and size after use and with negative proteinuria&#46;</p><p class="elsevierStylePara">Angiomyolipoma &#40;AML&#41; is the most common renal lesion in TS &#40;34-80&#37;&#41;&#44; followed by renal cysts and polycystic disease&#46; This is due to the fact that the TSC2 locus is adjacent to one of the polycystic kidney disease genes &#40;PKD1&#41; and adjacent deletions can produce both phenotypes&#46;</p><p class="elsevierStylePara">Angiomyolipoma is a benign tumour of the renal cortex&#44; characterised by the presence of mature or immature fatty tissue&#44; vascular wall and smooth muscle though with the capacity to provoke severe haemorrhage&#44; replacement of renal parenchyma and mass effect&#44; which can induce pain and may compromise renal function&#46;<span class="elsevierStyleSup">1</span> Renal failure is less frequent&#44; and is generally associated with glomerulosclerosis secondary to hyperfiltration as a result of surgery or tumoral invasion&#44; 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Article information
ISSN: 20132514
Original language: English
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2023 July 28 23 51
2023 June 39 33 72
2023 May 33 41 74
2023 April 17 18 35
2023 March 37 24 61
2023 February 19 28 47
2023 January 26 18 44
2022 December 32 26 58
2022 November 30 29 59
2022 October 32 30 62
2022 September 24 21 45
2022 August 22 47 69
2022 July 22 38 60
2022 June 20 35 55
2022 May 17 28 45
2022 April 30 50 80
2022 March 22 33 55
2022 February 26 33 59
2022 January 22 27 49
2021 December 16 36 52
2021 November 30 29 59
2021 October 18 37 55
2021 September 23 29 52
2021 August 18 24 42
2021 July 16 34 50
2021 June 25 15 40
2021 May 17 19 36
2021 April 35 16 51
2021 March 29 11 40
2021 February 41 14 55
2021 January 23 55 78
2020 December 16 5 21
2020 November 9 10 19
2020 October 10 5 15
2020 September 11 6 17
2020 August 15 5 20
2020 July 16 4 20
2020 June 17 6 23
2020 May 21 10 31
2020 April 19 6 25
2020 March 14 6 20
2020 February 24 15 39
2020 January 39 14 53
2019 December 20 9 29
2019 November 10 7 17
2019 October 13 6 19
2019 September 14 14 28
2019 August 15 9 24
2019 July 13 15 28
2019 June 13 12 25
2019 May 15 1 16
2019 April 45 33 78
2019 March 14 19 33
2019 February 12 12 24
2019 January 14 14 28
2018 December 47 27 74
2018 November 76 8 84
2018 October 81 9 90
2018 September 52 12 64
2018 August 20 8 28
2018 July 25 7 32
2018 June 20 7 27
2018 May 22 11 33
2018 April 21 4 25
2018 March 29 5 34
2018 February 21 6 27
2018 January 29 3 32
2017 December 35 9 44
2017 November 23 3 26
2017 October 24 5 29
2017 September 23 9 32
2017 August 24 8 32
2017 July 24 5 29
2017 June 27 13 40
2017 May 31 13 44
2017 April 30 7 37
2017 March 22 4 26
2017 February 24 4 28
2017 January 15 6 21
2016 December 40 3 43
2016 November 44 12 56
2016 October 63 5 68
2016 September 67 3 70
2016 August 69 3 72
2016 July 78 7 85
2016 June 85 0 85
2016 May 80 0 80
2016 April 56 0 56
2016 March 59 0 59
2016 February 69 0 69
2016 January 85 0 85
2015 December 98 0 98
2015 November 73 0 73
2015 October 73 0 73
2015 September 62 0 62
2015 August 57 0 57
2015 July 41 0 41
2015 June 25 0 25
2015 May 53 0 53
2015 April 5 0 5
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