Nefrología : publicación oficial de la Sociedad Española Nefrologia
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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. ⋯ 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; 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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Comment Letter Case Reports
[Impactation of permanent tunneled catheter for hemodialysis in the jugular vein, an exceptional complication].
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Ischemic nephropathy could be complicated with hypertension and acute worsening of chronic renal failure secondary to ACE inhibitors or AT receptor antagonist treatments and arterial occlusion. We describe a patient with bilateral renal artery stenosis and hypertension treated with ATI receptor antagonist (valsartan) that developed rapid worsening of renal function that required dialysis. Percutaneous transluminal renal artery angioplasty and stenting, complemented with hydratation and valsartan suppression achieves rapid and sustained recovery of renal function.
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Comparative Study
[Fistulae or catheter for elderly who start hemodialysis without permanent vascular access?].
Autologous access is the best vascular access for dialysis also in older patients and it should be mature when patient needs hemodialysis. It is not always possible. Surgeon availability and demographic characteristics of patients (age, diabetes, vascular disease...) are factors that determine primary vascular access. ⋯ Elderly who start hemodialysis without vascular access took longer to get a suitable permanent vascular access when arterio-venous fistulae is placed than with a tunnelled cuffed hemodialysis catheter. As a consequence, vascular access complications are larger, infection ones are the most common. In these patients a tunnelled catheter should be inserted at the time a peripheral arterio-venous access is created, in order to avoid temporary untunnelled catheters.
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Epidemiological and clinical studies have shown that cardiovascular disease in patients with end-stage renal disease (ESRD) is frequently related to damage of large conduit arteries. Arterial disease is responsible for the high incidence of ischemic heart disease, peripheral artery diseases, left ventricular hypertrophy and congestive heart failure. The vascular complications in ESRD are due to two different but associated mechanisms, namely atherosclerosis and arteriosclerosis. ⋯ The main clinical characteristics of arterial stiffening are changes in blood pressure with isolated increase in systolic pressure and normal or lower diastolic pressure. The consequences of these alterations are: (i) an increased LV afterload with development of LV hypertrophy and increased myocardial oxygen demand, and (ii) altered coronary perfusion and subendocardial blood flow distribution. Epidemiological studies have identified arterial remodeling and stiffening as independent predictors of overall and cardiac mortality in ESRD patients.