Lanzarini V V, Furusawa E A, Sadeck L, Leone C R, Vaz F A C, Koch V H
Pediatric Nephrology Unit, Instituto da Criança, Nursery Annex to the Maternity, HC FMUSP, Sao Paulo, Brazil.
J Hum Hypertens. 2006 Sep;20(9):679-83. doi: 10.1038/sj.jhh.1002051. Epub 2006 May 18.
An increase in the survival of neonates with antenatal diagnosis of malformations was achieved by the recent technical advances in neonatal intensive care units. The aim of this article is to describe the experience with neonatal arterial hypertension, in newborns with nephro-urological malformations, in a tertiary care referral Nursery, in a period of 4 years. Newborn medical records from the Nursery Annex to the Maternity of Hospital das Clinicas, School of Medicine, University of Sao Paulo, with the diagnosis of nephro-urological malformations and systemic arterial hypertension (SAH) at hospital discharge, in a period from January 1999 to January 2003, were retrospectively analysed. Among 10.278 live newborns in the studied period, 15 (0.15%) newborns were compatible with our inclusion criteria. Of these 15 newborns, 12 (80%) were male and three were premature (20%). In relation to aetiology, 13 (87%) showed urological malformations, 1 (6%) chronic renal insufficiency secondary to kidney dysplasia and one (6%) autosomal recessive polycystic kidney disease. SAH control was achieved with monotherapy in eight patients (53%), five patients (33%) needed an association of two drugs (calcium-channel blocker and angiotensin converting enzyme (ACE) inhibitor), one child used three types of antihypertensive drugs (calcium-channel blocker, ACE inhibitor and hydrochlorothiazide) for pressoric control and one child's blood pressure (BP) was controlled exclusively by peritoneal dialysis. The incidence of nephro-urological malformations in our service during the studied period was 0.89%. SAH incidence among these newborns was 19%. Our data reinforce previous studies pointing to the necessity to consider children with nephro-urological malformations as a risk group for SAH, who should have the BP evaluated since the neonatal period.
新生儿重症监护病房最近的技术进步使产前诊断出畸形的新生儿存活率有所提高。本文旨在描述一家三级医疗转诊托儿所4年间对患有肾-泌尿系统畸形的新生儿的新生儿动脉高血压治疗经验。对圣保罗大学医学院临床医院附属托儿所1999年1月至2003年1月期间出院诊断为肾-泌尿系统畸形和系统性动脉高血压（SAH）的新生儿病历进行回顾性分析。在研究期间的10278例活产新生儿中，15例（0.15%）符合纳入标准。这15例新生儿中，12例（80%）为男性，3例为早产儿（20%）。病因方面，13例（87%）表现为泌尿系统畸形，1例（6%）为肾发育不良继发慢性肾功能不全，1例（6%）为常染色体隐性多囊肾病。8例患者（53%）通过单一疗法实现了SAH控制，5例患者（33%）需要联合两种药物（钙通道阻滞剂和血管紧张素转换酶（ACE）抑制剂），1例患儿使用三种降压药物（钙通道阻滞剂、ACE抑制剂和氢氯噻嗪）控制血压，1例患儿的血压仅通过腹膜透析得到控制。研究期间我们科室肾-泌尿系统畸形的发病率为0.89%。这些新生儿中SAH的发病率为19%。我们的数据强化了之前的研究，表明有必要将患有肾-泌尿系统畸形的儿童视为SAH的风险群体，他们应自新生儿期起就接受血压评估。
