Renovascular hypertension in a 12 month old boy: what can the radiologist do?

We report a clinical case of renovascular disease, probably linked to fibromuscular dysplasia, in a 12 months old boy with severe arterial hypertension with target-organ damage, highlighting the radiological approach. Initial investigation included renal ultrasound that showed normal sized kidneys, with normal cortical echogenicity on the right and focally increased echogenicity of the posterior aspect of the left kidney, forming a mass-like lesion. Magnetic resonance imaging excluded renal tumor, which was confirmed by ultrasound guided biopsy. A doppler ultrasonography was also performed suggesting a right renal artery stenosis and decreased flow to the posterior aspect of the left kidney. Angiography with diagnostic and therapeutic intention was performed: right renal artery stenosis was detected and transluminal ballon dilation was performed; the left renal artery bifurcated precociously and the branch that irrigated the posterior part of the kidney had a stenosis which was also successfully dilated. After the intervention good blood pressure control with antihypertensive drugs was achieved, which was not possible before the angiographic procedure. The authors underline various methods of imaging used to accurately diagnose renovascular disease and the usefulness of interventional radiology treatment for this disease in very young children.

Impaired renal endothelial nitric oxide synthase and reticulocyte production as modulators of hypertension induced by recombinant human erythropoietin in the rat

INTRODUCTION AND AIMS: Hypertension is a common side effect of recombinant human erythropoietin (rHuEPO) therapy; however, the exact pathways remain to be elucidated. The discovery of non-hematopoietic actions of rHuEPO increased the number of patients that could putatively benefit from this therapy; however, to achieve those effects higher doses are usually needed, which increase the risk and incidence of adverse events. Our aim was to study the effect of a broad range of rHuEPO doses on hematological and biochemical parameters, blood pressure and renal function and damage in the rat, focusing on endothelial nitric oxide synthase (eNOS) and hypoxia-inducible factors (HIFs). METHODS: Male Wistar rats were divided in 5 groups receiving different doses of rHuEPO (100, 200, 400 and 600 IU/kg body weight (BW)/week) and saline solution (control), during 3 weeks. Blood and 24h urine were collected to perform hematological and biochemical analysis. Blood pressure (BP) was measured by the tail-cuff method. The kidney tissue was collected to mRNA and protein expression assays and to characterize renal lesions. RESULTS: A dose-dependent increase in red blood cells count, hematocrit and hemoglobin levels was found with rHuEPO therapy, in rHuEPO200, rHuEPO400 and rHuEPO600 groups. Increased reticulocyte count was found in the rHuEPO400 and rHuEPO600 groups. BP raised in all groups receiving rHuEPO. The rHuEPO200 and rHuEPO600 groups presented increased kidney protein levels of HIF2α and a reduction in kidney protein levels of eNOS, along with the highest grade of vascular and tubular renal lesions. CONCLUSIONS: Our study showed that rHuEPO-induced hypertension might involve indirect (hematological) and direct (renal) effects which varies according to the dose used. Thus, rHuEPO therapy should be performed rationally and under adequate surveillance, as hypertension develops even with lower doses. Especial caution with higher doses should be taken, as rHuEPO-induced hypertension leads to early renal damage without alterations in traditional markers of renal function, thus masking the serious adverse effects and risks.

Cost of worksite hypertension treatment /

Mode of access: Internet.

Bibliografia generale riguardante la vulcanologia, mineralogia, geologia, paleontologia e paleoetnologia della provincia di Catania delle isole vulcaniche adiacenti alla Sicilia,

Mode of access: Internet.

Experimental renal hypertension,

Bibliography: p. 63-64.

Catalogo delle Piante dei Giardini d'Acclimazione delle Isole Borromee.

Mode of access: Internet.

Flora italiana; ossia, Descrizione delle piante che crescono spontanee o vegetano come tali in Italia e nelle isole ad essa aggaicenti; disposta secondo il metodo naturale.

"Elenco delle opere sulla flora italiana pui comunemente citate in questo libro": v. 8, p. [7]-14; v. 9, p. [5]-6. Index, 1896, inserted at end of v. 7.

Spiegazione e traduzione dei xiv quadri relativi alle isole di Salibaboo, Talaor, Sanguey, Nanuse, Mindanao, Celebes, Bornéo, Bahalatolis, Tambisan, Sulu, Toolyan,

Mode of access: Internet.

Istoria della conuersione alla nostra santa fede dell'Isole Mariane, dette prima de'Ladroni, nella vita, predicatione, e morte gloriosa per Christo del venerable P. Diego Luigi di Sanuitores, e d'altri suoi compagni della Compagnia di Giesù /

Mode of access: Internet.

Notizie sulle isole Linosa, Lampione, e Lampedusa, e descrizione di una nuova specie di Stapelia che trovasi in questa ultima.

"Prospetto delle famiglie naturali delle piante fanerogame vegetanti e numero delle specie che comprendono," p. 92.

Memorie storiche delle Isole de della Badía di Tremiti.

Mode of access: Internet.

Viaggio intorno al globo : principalmente alla California ed alle isole Sandwich negli anni 1826, 1827, 1828 e 1829 /

Translation of the author's "Voyage autour du monde..." Paris, 1834-35.

The nun (L'isolée)

Mode of access: Internet.

Spontaneous hypertension, its pathogenesis and complications : proceedings of the 2d International Symposium on the Spontaneously Hypertensive Rat /

Mode of access: Internet.

Life stress and essential hypertension; a study of circulatory adjustments in man,

Bibliography: p.234-245.