Hypertension and Unilateral Hydronephrosis in Children Successfully Treated by Pyeloplasty: Report of Two Cases By W. S. Chapman and B. S. Douglas
WO CHILDREN with unilateral hydronephrosis and hypertension with raised renal vein renins were treated by pyeloplasty resulting in a return of the blood pressure to normal.
Case I SC., a male, aged 10, presented with hematuria after minor trauma. Examination of the abdomen revealed a mass in the left flank. The blood pressure was 150/95 and an intravenous pyelogram showed gross hydronephrosis on the left side due to pelviureteric obstruction. The hematuria cleared in 2 wk. One month after presentation his blood pressure was 140/95 and a repeat pyelogram was unchanged. Five months after presentation renal vein renin tests were performed (by bioassay). The left renal vein was 2503 ng/lMl ml/3 hr and the right renal vein renin was 1450 ng/lOO ml/3 hr~--a ratio Left to right of I .7/ 1-and total levels raised above normal. A modified Hynes Anderson pyeloplasty was performed. he became normotensive on the seventh postoperative day and has remained so for 5 yr. His latest blood pressure was 120/80, and the intravenous pyelogram shows unchanged hydronephrosis with improved function and good drainage. Postoperative renal vein renin tests were not done.
Case 2 L.B., a female aged IO, presented with a urinary tract infection. Three days later she developed pain and tenderness in the right loin and gross hematuria developed. She was admitted for study. An intravenous pyelogram showed hydroenphrosis on the right side due to pelviureteric obstruction. The blood pressure was l75/ I IO. Bilateral renal vein renin measurements were made (by radioimmunoassay). The right renal vein renin activity was 190 ng/ml/hr and the left renal vein renin activity was 140 ng/ml/hr. These results showed elevation on both sides. The peripheral vein plasma renin activity was also elevated. (9.0 ngj ml/hr. Normal-O.54 ng/ml/hr). .4 modified Hynes Anderson pyeloplasty was performed. She became normotensive on the 10th postoperativeday and has remained so for IO mop-the last reading being I10/65. Peripheral vein plasma renin activity test was repeated 3 months after operation. The result was 0.77 ng/ml/hr. Normal-O.38 * 0.29 ng/ml/hr.
Animal experiments have shown that unilateral hydronephrosis is associated with hypertension.’ However, a recent comprehensive review of hypertension in children merely lists hydronephrosis as a cause without further discussion.” Three cases of raised renal vein renin levels or ratios have been reported in From
rralia. Address hing
1975 by Grune
B S. Douglas