小児腎血管性高血圧症の3例

Abstract

Renovascular hypertension in children is relatively rare than III adults, and only 14 cases of children have been reported although 161 patients undergoing operation of renovascular hypertension are found in the previous literatures in Japan until 1972. Case 1: A 11-year-old male was admitted to the hospital with chief complaint of severe headache. Blood pressure was 160-180/80-110mmHg. Plasma renin activity was 102ng/ml in the right renal vein, 41.2ng/ml in the left renal vein. From these datas and the results of differential renal urinalysis, right renovascular hypertension was suspected although bilateral renal arterial stenosis was found from the renal arteriograms. The right aorto-renal arterial anastomosis was done on June 18, 1973, and the blood pressure has been normal since the fifth postoperative day. Case 2: A 3-year-old male was admitted to the hospital with the complaints of vomiting, general rigidity and sweating. Blood pressure was 180-220/100-150 mmHg. Plasma rennin activity was 74.5ng/ml in the right renal vein and 63.7 ng/ml in the left renal vein. Renal arteriograms showed remarkable stenosis of the right renal artery. The right kidney was removed after reconstruction of the right renal artery was done unsuccessfully on October 1, 1973, and the blood pressure has been normal since the thirteenth postoperative day. Case 3: A 12-year-old male was admitted to the hospital with complaints of severe headache and cramp attack. Blood pressure was 210-260/130-200 mmHg. Plasma rennin activity was 281ng/ml in the right renal vein, 76ng/ml in the left renal vein. Renal arteriography was made and the right renal artery was completely obstructed at about 0.5cm apart from the origin. The right nephrectomy was done on November 12, 1973, and the blood pressure has been normal since the seventh postoperative day. Three cases of renovascular hypertension in children recently treated in our hospital have been reported. The blood pressure of all patients has become normal level after the surgical procedures. Histology of the stenotic portion of the renal artery showed intimal fibromuscular hyperplasia in case 1 and 2, and organised thrombus in case 3.