RESUMO
We present a 7-year-old child with uncontrolled hypertension caused by bilateral renal artery stenosis. He underwent renal angioplasty on both sides. While the right side showed successful dilatation, the left side was unsuccessful, leaving a near total occlusion. Due to the lack of satisfactory control of his blood pressure, he was scheduled for an iliorenal bypass. Following surgery, all antihypertensive medications were withdrawn. Computed tomography angiography performed 18 months after surgery showed patent angioplasty on the right side and patent bypass on the left side. Both endovascular and open surgical treatments are feasible options with good results in this age group.
Assuntos
Angioplastia com Balão , Hipertensão Renovascular/terapia , Artéria Ilíaca/cirurgia , Obstrução da Artéria Renal/terapia , Artéria Renal/cirurgia , Veia Safena/transplante , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Criança , Terapia Combinada , Humanos , Hipertensão Renovascular/diagnóstico , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/fisiopatologia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Masculino , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
BACKGROUND: Primary nephrotic syndrome is a common renal problem in pediatrics, with great variation in patients' characteristics in different regions of the world. The aim of this study was to define these characteristics in Egyptian children with primary nephrotic syndrome. METHODS: Records of 100 primary nephrotic syndrome patients were retrospectively reviewed. Demographic, clinical, histopathological data and response to therapy were analyzed. RESULTS: The mean age of onset was 4.43 ± 2.7 years. Thirty-four percent of patients were steroid resistant, and 66% showed initial steroid response; 46 of the latter were steroid dependent. Forty patients underwent a renal biopsy with minimal change nephrotic syndrome occurring in 30%, mesangioproliferative glomerulonephritis in 37.5% and focal segmental glomerulosclerosis in 30%. Nine percent of cases developed chronic renal insufficiency. Response to cyclophosphamide and cyclosporine occurred in 37.5% and 33.3% of steroid-resistant nephrotic syndrome patients, respectively. CONCLUSIONS: A greater percentage of steroid-resistant patients were found in our patients compared with those in other studies. Response to immunosuppressives was different from other studies, probably due to differences in the priority of selection for immunosuppressive therapy.