engleski

Hypertensive crisis as the first manifestation of renal disease in children and adolescents: a report of three cases and review of the literature

Introduction: Hypertensive crisis is a life- threatening condition, defined as severe hypertension complicated with acute target- organ dysfunction (mainly neurological, renal or cardiac). It rarely occurs in childhood and most children and adolescents who presents with hypertensive crises symptoms have secondary hypertension, mainly of renal etiology. Case reports: We present the cases of three children with severe hypertension of different renal etiology who presented with the characteristic features of hypertensive emergency. Case 1 is a 11-year-old girl with reflux nephropathy who at admission had blood pressure (BP) as high as 250/200 mmHg. She was lethargic, with headache, vomiting and a 3-month history of weight loss. Case 2 is a 13-year-old boy with renal artery stenosis who had clinical presentation of generalized tonic-clonic seizures and BP 220/150 mmHg. Case 3 is a 9-year-old boy with chronic renal insufficiency of unexplained etiology and BP as high as 220/135 mmHg. This patient, like two others, presented dominantly with symptoms of hypertensive encephalopathy, as well as signs of renal damage. All three patients have documented hypertrophic cardiomyopathy. In the patient who had renal artery stenosis, removal of his dysplastic atrophic right kidney failed to normalize his blood pressure. Conclusion: We discuss the cases of unrecognized long-standing hypertension, with progression to malignant hypertension, as the first manifestation of renal disease - two with renal parenchymal disorders and one with renovascular disease. Hypertension is underdiagnosed in children and thev purpose of these case reports is to raise awarness about it and point to the importance of routine careful measurement of blood pressure in pediatric patients.

hypertensive crisis; renal disease; children; hypertension; adolescent; presentation

nije evidentirano