Abstract
The aim of this report was to estimate the risk of hypertension in children with primary vesicoureteral reflux (VUR). Between 1970 and 2004, 735 patients were diagnosed with VUR at a single tertiary renal unit. Of 735 patients, 664 (90%) were systematically followed and had multiple measurements of blood pressure. Hypertension was defined as values persistently above 95th for age, sex, and height in three consecutive visits. Risk of hypertension was analyzed by the Kaplan-Meier method. Of 664 patients followed, 20 (3%) developed hypertension. The estimated probability of hypertension was 2% (95%CI, 0.5%–3%), 6% (95%CI, 2%–10%), 15% (95%CI, 11%–20%) at 10, 15, and 21 years of age, respectively. The prevalence of hypertension has increased with age: it was 1.7% for patients with 1 yr–9.9 yr, 1.8% for adolescents with 10 yr–14.9 yr, 4.7% for patients with 15–19.9 yr, and 35% for patients >20 years at the end of the follow-up (P < 0.001). It was estimated by survival analysis that 50% of patients with unilateral and bilateral renal damage would have sustained hypertension at about 30 and 22 years of age, respectively. Hypertension increased with age and was strongly associated with renal damage at entry in an unselected population of primary VUR.
References
Goonasekera CD, Dillon MJ (1999) Hypertension in reflux nephropathy. BJU Int 83(Suppl 3):1–12
Farnham SB, Adams MC, Brock JW 3rd, Pope JC (2005) Pediatric urological causes of hypertension. J Urol 173:697–704
Blumenthal I (2006) Vesicoureteric reflux and urinary tract infection in children. Postgrad Med J 82:31–35
Heale WF (1977) Hypertension and reflux nephropathy. Aust Paediatr J 13:56
Wallace DM, Rothwell DL, Williams DI (1978) The long-term follow-up of surgically treated vesicoureteric reflux. Br J Urol 50:479–484
Silva JM, Santos Diniz JS, Marino VS, Lima EM, Cardoso LS, Vasconcelos MA, Oliveira EA (2006) Clinical course of 735 children and adolescents with primary vesicoureteral reflux. Pediatr Nephrol 21:981–988
National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents (1996) Update on the 1987 Task Force Report on high blood pressure in children and adolescents: A working group report from the National High Blood Pressure Education Program. Pediatrics 98:649–658
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576
Silva JM, Diniz JS, Silva AC, Azevedo MV, Pimenta MR, Oliveira EA (2006) Predictive factors of chronic kidney disease in severe vesicoureteral reflux. Pediatr Nephrol 21:1285–1292
Goldraich NP, Ramos OL, Goldraich IH (1989) Urography versus DMSA scan in children with vesicoureteric reflux. Pediatr Nephrol 3:1–5
Smellie JM (1995) The intravenous urogram in the detection and evaluation of renal damage following urinary tract infection. Pediatr Nephrol 9:213–219
Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observation. J Am Statis Ass 53:457–481
Wolfish NM, Delbrouck NF, Shanon A, Matzinger MA, Stenstrom R, McLaine PN (1993) Prevalence of hypertension in children with primary vesicoureteral reflux. J Pediatr 123:559–563
Smellie JM, Prescod NP, Shaw PJ, Risdon RA, Bryant TN (1998) Childhood reflux and urinary infection: a follow-up of 10–41 years in 226 adults. Pediatr Nephrol 12:727–736
Zhang Y, Bailey RR (1995) A long term follow up of adults with reflux nephropathy. N Z Med J 108:142–144
Lahdes-Vasama T, Niskanen K, Ronnholm K (2006) Outcome of kidneys in patients treated for vesicoureteral reflux (VUR) during childhood. Nephrol Dial Transplant 21:2491–2497
Bachmann H (1982) Hypertension, a frequent complication in children and adolescents with reflux nephropathy. Klin Padiatr 194:152–153
Acknowledgements
This study was partially supported by CNPq (Brazilian National Research Council), Pró-Reitoria de Pesquisa (UFMG), and FAPEMIG. MAV and MRP were the recipients of CNPq fellowships. Dr. E.A. Oliveira received a research grant from the Brazilian Research Council (CNPq).
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Simoes e Silva, A.C., Silva, J.M.P., Diniz, J.S.S. et al. Risk of hypertension in primary vesicoureteral reflux. Pediatr Nephrol 22, 459–462 (2007). https://doi.org/10.1007/s00467-006-0349-2
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DOI: https://doi.org/10.1007/s00467-006-0349-2