肾血管性高血压和自体移植后看似无功能的肾脏再生:来自20多年随访的珍珠

IF 0.4 4区 医学 Q4 PEDIATRICS
Afarin Neishabouri, Parham Torabinavid, A. Kajbafzadeh
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引用次数: 0

摘要

导读:肾血管性高血压是导致儿科严重高血压的重要原因之一。主要的治疗方法,包括药物治疗或血管成形术,并不总是可行的,其效果是可变的。同时,一些导致肾功能损害的情况,包括严重的肾动脉狭窄,可能在各种成像方式下代表相应的肾脏是一个明显无功能的器官。我们的目的是证明,在一个没有治疗的肾血管性高血压和严重肾动脉狭窄的儿童的身体唯一的器官是同侧无功能的肾脏。肾动脉狭窄保护肾脏免于高血压。在这种情况下,自体肾移植(RAT)可以优于肾切除术,以防止严重的高血压。这种现象可以通过移植肾的高血压控制和肥厚并伴有对侧代偿性肥厚缩小来证实。病例介绍:我们介绍一名14岁的儿童,7年前被诊断为高血压,目前对四种药物治疗有耐药性。肾显像和静脉肾盂造影未发现与相对肾有关的活动,血管造影显示肾动脉严重狭窄,血液循环保留。根据术前和术后静脉肾盂造影,自体肾移植成功地恢复了各自肾脏的功能,并将血压降至正常范围。结论:我们的经验表明,我们不能仅仅根据常规成像方式(包括静脉肾盂造影、闪烁成像和双工超声)的初步发现来标记肾脏为“无功能”器官。此外,在血管成形术失败或不可行的情况下,肾脏自体移植可能是一种安全的替代方案,对肾血管性高血压患者来说,能够恢复肾脏功能,结果很有希望。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Renovascular Hypertension and Seemingly Non-functioning Kidney Renewed Following Auto-transplantation: Pearls from Over Two Decades of Follow-up
Introduction: Renovascular hypertension is among the significant causes of severe hypertension in pediatrics. Primary therapeutic approaches, including drug therapy or angioplasty, are not always feasible, and their effectiveness is variable. Meanwhile, several conditions leading to renal function impairment, including severe renal artery stenosis, may represent the respective kidney as an apparently non-functioning organ in various imaging modalities. We aim to demonstrate that the only organ in the body of a child with non-treated renovascular hypertension and severe renal artery stenosis is the ipsilateral non-functioning kidney. This kidney is alive and protected from hypertension by renal artery stenosis. Renal autotransplantation (RAT) can be superior to nephrectomy in such cases to protect from severe hypertension. This phenomenon can be confirmed by controlled hypertension and hypertrophy of transplanted kidney accompanied by shrinkage of contralateral compensatory hypertrophy. Case Presentation: We introduce a 14-year-old child with a history of diagnosed hypertension from seven years ago, presenting with resistance to four-drug therapy. Renal scintigraphy and intravenous pyelography found no activity pertaining to the relative kidney, and angiography exhibited severe stenosis of the renal artery with preserved blood circulation. Renal autotransplantation successfully restored the function of the respective kidney based on pre-and post-surgery intravenous pyelography and decreased the blood pressure to normal limits. Conclusions: Our experience shows we cannot mark a kidney as a "non-functioning" organ only on the basis of the preliminary findings from conventional imaging modalities, including intravenous pyelography, scintigraphy, and duplex ultrasound. Moreover, in cases that angioplasty is failed or is not feasible, renal auto-transplantation may be a safe alternative with promising outcomes in patients with renovascular hypertension, being able to restore the function of the kidney.
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来源期刊
CiteScore
0.90
自引率
20.00%
发文量
75
审稿时长
6-12 weeks
期刊介绍: Iranian Journal of Pediatrics (Iran J Pediatr) is a peer-reviewed medical publication. The purpose of Iran J Pediatr is to increase knowledge, stimulate research in all fields of Pediatrics, and promote better management of pediatric patients. To achieve the goals, the journal publishes basic, biomedical, and clinical investigations on prevalent diseases relevant to pediatrics. The acceptance criteria for all papers are the quality and originality of the research and their significance to our readership. Except where otherwise stated, manuscripts are peer-reviewed by minimum three anonymous reviewers. The Editorial Board reserves the right to refuse any material for publication and advises that authors should retain copies of submitted manuscripts and correspondence as the material cannot be returned. Final acceptance or rejection rests with the Editors.
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