Renovascular disease in children.
Renovascular disease in children.
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儿童肾血管疾病。
DOI：
10.1038/ki.1993.72
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发表时间：
1993
影响因子：
19.6
通讯作者：
Ingelfinger,JR
中科院分区：
文献类型：
--
作者：
Ingelfinger,JR
讨论 DR. JULIE R. INGELFINGER（马萨诸塞州总医院儿科肾病科联合主任，马萨诸塞州波士顿哈佛医学院儿科副教授）：现在，即使新生儿也有血压标准，儿童中原发性高血压的诊断越来越频繁。然而，非常年幼的儿童（例如这里描述的小女孩）的严重高血压仍然更有可能是由于明确的高血压原因造成的，而不是所谓的原发性高血压[1]。在整个儿科人群中 [2]，肾脏和肾血管疾病占生命最初几年可定义高血压的近 90%；这个百分比实际上可能更高。在当前的讨论中，我将首先关注儿童早期的肾血管疾病，并介绍有关其病因、评估和治疗的当前知识。我将重点关注引起高血压的血管变化，而较少关注血压升高导致的变化。然后，我将讨论肾脉管系统的发育以及对其正常生长和重塑可能重要的因素。最后，我将简要考虑神经纤维瘤病患者肾动脉脉管系统的具体异常。 病因学 尽管只有少数动脉病变在儿童中常见，但多种疾病可导致肾性和肾血管性高血压。在 20 世纪 60 年代末和 70 年代初，McCormack 及其同事根据所涉及的血管壁层开发了一种分类方法；该分类方案是当前用于描述肾血管病变的框架[3, 4]。表1列出了肾血管性高血压的常见原因；让我简要回顾一下这些内容。
DiscussionDR. JULIE R. INGELFINGER (Co-Director, Pediatric Nephrol-ogy Unit, Massachusetts General Hospital, and Associate Professor of Pediatrics, Harvard Medical School, Boston, Massachusetts): Primary hypertension is diagnosed in children more and more frequently now that blood pressure norms are available even for newborns. However, severe hypertension in a very young child, such as the little girl described here, is still much more likely to be due to a definable cause of hypertension than to represent so-called primary hypertension [1]. In the overall pediatric population [2], renal and renovascular diseases account for close to 90% of definable hypertension in the first years of life; the percentage actually might be even higher. For the current discussion, I will first focus on renovascular disease in early childhood and present the current knowledge about its cause, evaluation, and therapy. I will focus on the vascular changes that produce hypertension and will concentrate less on changes that result from elevated blood pressure. I then will discuss the development of the renal vasculature and factors that might be important in its normal growth and remodeling. Finally, I will consider briefly the specific abnormalities in the renal artery vasculature in patients with neurofibromatosis.Etiology A variety of diseases can lead to renal and renovascular hypertension, although only a few arterial lesions are common in children. In the late l960s and early 1970s, McCormack and colleagues developed a classification based on the layer of the vascular wall involved; this classification scheme is the current framework used to describe renovascular lesions [3, 4]. Table 1 lists the common causes of renovascular hypertension; let me review these briefly.