Department of Pediatrics, 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.
Department of Pediatrics, Dr. von Hauner Children´s Hospital, University Hospital, LMU Munich, Munich, Germany.
Eur J Pediatr. 2021 Dec;180(12):3599-3603. doi: 10.1007/s00431-021-04165-1. Epub 2021 Jun 26.
Cystic kidney diseases such as autosomal recessive or dominant polycystic kidney disease (ARPKD and ADPKD) are associated with high prevalence of arterial hypertension. On the contrary, studies on hypertension in children with renal cysts and diabetes (RCAD) syndrome caused by abnormalities in the HNF1B gene are rare. Therefore, the primary aim of our study was to investigate the prevalence of high blood pressure in children with RCAD syndrome due to HNF1B gene abnormalities and secondary to search for possible risk factors for development of high blood pressure. Data on all children with genetically proven RCAD syndrome from three pediatric nephrology tertiary centers were retrospectively reviewed (office blood pressure (BP), ambulatory blood pressure monitoring (ABPM), creatinine clearance, renal ultrasound, echocardiography, albuminuria/proteinuria). High blood pressure was defined as BP ≥ 95th percentile of the current ESH 2016 guidelines and/or by the use of antihypertensive drugs. Thirty-two children with RCAD syndrome were investigated. Three children received ACE inhibitors for hypertension and/or proteinuria. High blood pressure was diagnosed using office BP in 22% of the children (n = 7). In the 7 performed ABPM, 1 child (14%) was diagnosed with hypertension and one child with white-coat hypertension. Creatinine clearance, proteinuria, albuminuria, body mass index, enlargement, or hypodysplasia of the kidneys and prevalence of HNF1B-gene deletion or mutation were not significantly different between hypertensive and normotensive children.Conclusion: High blood pressure is present in 22% of children with RCAD syndrome. What is Known: • Arterial hypertension is a common complication in children with polycystic kidney diseases. What is New: • High office blood pressure is present in 22% and ambulatory hypertension in 14% of children with renal cyst and diabetes (RCAD) syndrome.
常染色体隐性或显性多囊肾病(ARPKD 和 ADPKD)等囊性肾病与动脉高血压的高患病率相关。相反,由于 HNF1B 基因突变引起的儿童肾囊肿糖尿病(RCAD)综合征的高血压研究较为罕见。因此,我们研究的主要目的是调查由于 HNF1B 基因突变引起的 RCAD 综合征儿童高血压的患病率,并进一步寻找高血压发展的可能危险因素。对来自三个儿科肾脏病三级中心的所有经基因证实的 RCAD 综合征儿童的数据进行回顾性分析(诊室血压(BP)、动态血压监测(ABPM)、肌酐清除率、肾脏超声、超声心动图、蛋白尿/蛋白尿)。高血压定义为 BP≥ESH 2016 指南当前第 95 百分位数和/或使用降压药物。研究了 32 名 RCAD 综合征患儿。3 名儿童因高血压和/或蛋白尿接受 ACE 抑制剂治疗。使用诊室 BP 诊断高血压的儿童占 22%(n=7)。在进行的 7 次 ABPM 中,1 名儿童(14%)被诊断为高血压,1 名儿童患有白大衣高血压。高血压儿童和血压正常儿童的肌酐清除率、蛋白尿、白蛋白尿、体重指数、肾脏增大或发育不良以及 HNF1B 基因突变缺失的发生率无显著差异。结论:RCAD 综合征患儿中 22%存在高血压。已知:•动脉高血压是多囊肾病儿童的常见并发症。新发现:•22%的 RCAD 综合征儿童存在诊室高血压,14%的儿童存在动态高血压。