Bunchman T E, Sinaiko A R
Division of Pediatric Nephrology, Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, MO 63104.
Pediatr Nephrol. 1990 Mar;4(2):169-70. doi: 10.1007/BF00858833.
This report describes two adolescents with severe hypertension secondary to renal artery stenosis who had evidence of a hypokalemic metabolic alkalosis in their initial laboratory evaluation. Hypokalemic metabolic alkalosis is known to occur in approximately 16% of adults with renal artery stenosis but has not been well described in the pediatric literature. It is the result of excess aldosterone secretion stimulated by renal artery stenosis-mediated activation of the renin-angiotension system and by an increase in natriuresis from the contralateral, non-stenotic kidney. Although primary hyperaldosteronism must be considered in children with hypertension and hypokalemia, it is a rare disease in children. This report supports current recommendations that the initial focus of medical investigation in the severely hypertensive child should remain on the kidney.
本报告描述了两名患有肾动脉狭窄继发严重高血压的青少年，他们在初次实验室评估时有低钾性代谢性碱中毒的证据。已知低钾性代谢性碱中毒约发生在16%的肾动脉狭窄成人中，但在儿科文献中尚未得到充分描述。它是由肾动脉狭窄介导的肾素-血管紧张素系统激活以及对侧非狭窄肾脏钠排泄增加刺激醛固酮分泌过多所致。虽然高血压和低钾血症患儿必须考虑原发性醛固酮增多症，但这在儿童中是一种罕见疾病。本报告支持当前的建议，即重度高血压儿童医学检查的初始重点应仍然放在肾脏上。
