A case report of renal calyceal diverticulum with hypertension in children and review of literature

Background Renal calyx diverticulum refers to a cystic lesion covered with the transitional epithelium in the renal parenchyma. Although there is no clear evidence that calyx diverticulum can cause hypertension, there exists a close association between the two, and there are few related reports. Herein, we reported the case of a child with renal calyx diverticulum complicated with hypertension and summarized the diagnosis and treatment. Case presentation Physical examination of the patient, an 11-year-old child, revealed a left renal cyst with hypertension (155/116 mmHg). There were no related symptoms. Routine urine and blood biochemical examinations showed no abnormalities. Imaging revealed left renal cyst compression causing the hypertension. She underwent renal cyst fluid aspiration and injection of a sclerosing agent into the capsule, but her blood pressure increased again 3 days postoperatively. Color Doppler ultrasonography showed that the size of the left renal cyst was the same as that preoperatively. To further confirm the diagnosis, cystoscopic retrograde ureteropyelography was performed to confirm the diagnosis of renal calyx diverticulum. Subsequently, renal calyceal diverticulum resection and calyx neck enlargement were performed. The operation went smoothly and the blood pressure returned to normal postoperatively. No abnormalities were noted at the 7-month postoperative follow-up. Conclusion There exists an association between renal calyx diverticulum and hypertension. Therefore, hypertension can be considered a surgical indication for renal calyx diverticulum. Moreover, renal calyceal diverticulum in children can be easily misdiagnosed as a renal cyst. Therefore, it is important to be vigilant to prevent a series of complications, such as postoperative urine leakage, in such cases.

Clinical impact of subcutaneous treprostinil in trisomy 21 patient with pulmonary arterial hypertension associated with CHD

Subcutaneous treprostinil is commonly used to improve idiopathic pulmonary arterial hypertension in children. However, its effectiveness has not been reported in trisomy 21. We report the case of 9-year-old boy in trisomy 21 with CHD-pulmonary artery hypertension after surgical correction of CHD. Haemodynamics and exercise capacity dramatically improved with a transition from oral selexipag to subcutaneous treprostinil.

Association Between Blood Pressure And Lung Function In Chinese Children: The Seven Northeastern Cities Study

Background: A global increase in asthma and COPD incidence has occurred, the cause is unknown. One potential relationship that has yet to be explored is the interaction between blood pressure (BP) and lung function in children 5-17 years old. Our purpose is to assess the relationship between hypotension, hypertension, and lung function in children 5 to 17 years old. Methods: Participants were recruited from elementary and middle schools from 7 cities in northeastern China (N=6,797). BP was categorized into 3 groups: hypotensive (<5th percentile or <90mmHg if children >10 years), normotensive and hypertensive (>95th percentile) based on American Academy of Pediatrics standards. Spirometry measured lung function in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), and maximum mid expiratory flow (MMEF). Associations were assessed using logistic regression analysis. Results: Decreases in FVC , FEV1, PEF, and MMEF were noted in hypotensive children. Higher FVC, FEV1, PEF, and MMEF were noted among children ³ 10 with hypertension, while children <10 years, only had increased FVC compared to normotensive children. Statistically significant interactions between hypotension and PEF < 75% (OR:2.31; 95% CI: 1.17-4.23), were seen for children < 10 years. Conclusions: Our findings suggest that, in this study population, hypotension may be associated with decreased lung function, and the increased lung function may be associated with hypertension in children. Future studies are needed to confirm temporality as this is the first study to explore these relationships in children which requires in depth investigation.

PULMONARY HYPERTENSION IN INFANTS WITH BRONCHOPULMONARY DYSPLASIA: CAUSES, DIAGNOSIS, TREATMENT

Bronchopulmonary dysplasia (BPD) is a leading chronic pathology of premature infants, which changes the structure of the lungs and disrupts the development of pulmonary vessels. The most important cardiovascular complication of BPD is the development of pulmonary hypertension, which is diagnosed in about 25 % of severely ill infants. Pulmonary hypertension associated with BPD develops due to lung vascular abnormalities and remodeling of the pulmonary vasculature, both of which lead to an increase in vascular resistance and the development of right ventricular heart failure. The occurrence of this complication worsens the prognosis of survival in infants with BPD, prolongs the total duration of hospital stay, adversely affects long-term somatic and neurological development and increases the frequency of re-hospitalizations. All this justifies the need for timely diagnosis and treatment of pulmonary hypertension in children with BPD. This review presents new data, for the definition, diagnosis, and treatment of pulmonary hypertension associated with BPD.