Up To Date in the diagnosis and treatment of high blood pressure in Pediatrics. Recommendations from the Nephrology Branch of the Chilean Society of Pediatrics Blood pressure (BP) is a vital sign routinely obtained in adult physical examination. This is not the case in children; therefore, high blood pressure in children is frequently not diagnosed. It should be measured with adequate equipment according to age and height of the child, considering that BP values increase under physiological conditions. Arterial hypertension is defined in percentiles for age, gender and height. Three categories can be established: normal BP, pre-hypertension and hypertension. Clinical studies have determined that the younger the child, the probability of secondary hypertension increases, usually of renal origin. Genetic and metabolic risk factors have been identified intrauterine; this "fetal programming" is related later in life with the onset of high blood pressure. Arterial hypertension evolves without symptoms for long periods of time, making more relevant a complete physical examination that includes BP. The hypertensive patient must be approached by age, clinical history, physical examination and BP values, followed by a laboratory work-up. Complementary studies including BP ambulatory monitoring are being used with increasing frequency in the pediatric population, allowing a big number of BP readings during diary activities of the child. Arterial hypertension treatment in pediatrics begins with the prevention of known risk factors, encouraging a change of lifestyle for the child and his/her family. Drug treatment must be reserved after secondary causes have been corrected and lifestyle modifications did not work out. Pharmacological treatment must be indicated individually, its efficacy monitored and potential adverse effects assessed. Still at an experimental stage, antihypertensive vaccination modifying the renin-angiotensin system is being studied.
Despite the fact that our study group behaved clinically similar to published HUS patients in other series, no mortality was observed in a retrospective analysis of patients with this disease.
Arterial hypertension and salt intake in pediatricsPediatric arterial hypertension (AH) is an underdiagnosed disease, with a known prevalence of 2-3%. Its preventive management should begin early and includes life-style changes and diet salt reduction to a maximum of 5.8 g (2.3 g of sodium), since there is a direct relationship between total salt intake and arterial blood pressure. It has been previously shown that in populations with low salt diet (less than 3g), AH is rare and it does not increase with age. It has been estimated that 77% of salt found in regular diets comes from processed food. Mechanisms involved in salt intake and high blood pressure are analyzed in this paper. Arterial hypertension secondary to renal diseases and other pathologies are excluded. Considering renal physiology, the role of the kidney is crucial in arterial blood pressure regulation, through the capacity to affect the salt and water excretion; therefore, controlling total blood volume. The relationship between salt and AH in the newborn and older children, as well as genetic aspects of this disease, are discussed. In conclusion, there are biological and behavioural risk factors that can be modified in young population. It is necessary to promote these changes through active, as well as passive, prevention strategies. A government public health policy including educational publicity campaigns, permanent media information and accessible health food labelling is essential. Habits, old customs and trends need to be changed through a multifactorial approach to groups, families and community. The pediatrician should lead this effort. RESUMENLa hipertensión arterial (HA) en pediatría es una patología sub diagnosticada, con una prevalencia de alrededor de un 2 a 3%. Su prevención debe comenzar precozmente con indicaciones de estilos de vida saludables, en especial reducción de sodio a 2,3 g equivalentes a 5,8 g de cloruro de sodio diarios, dada la relación directa entre cantidad de sal de la dieta y la presión arterial. En poblaciones humanas con dietas conteniendo menos de 3 g de sal por día la HA es infrecuente y no aumenta con la edad. La mayor parte del sodio ingerido se aporta por los alimentos elaborados industrialmente: el 77% se obtiene de los alimentos ACTUALIDAD CLINICAL OVERVIEW Rev Chil Pediatr 2009; 80 (1): 11-20
No abstract
Effects of two forms of vitamin D supplementationon bone metabolism and infants growth mont" of life. Weight, height, head circumference, serum cole urn, phosphorus, alkcl'ne phosohatcse, parathyroid hormone and 1.25 (OH) 2 vit D, were comoored. Statistically signif'cant favcuraole di^e'ences for daily doses were found from he thirc month on heigh*, from the sixth norrh on weight one fro 11 the eighth month of life on head c'rcunference. Blooc pressure was hiche-soecially 30.. 60, vO and 120 days aHer the first 6CO COO ID vit D megaccse. Mean serum 1 .25 (Oh)-, v't D, was cor-s'stently higher in oatiets given mosive vitamin doses,. I I 10 end 96 pg/m at third and sixh mo~m, as compa-ed wrh 55 pg/ml respective 1 )' in subjects irder cai : y doses).No statistic other differences were found in ot^er of blood measu r emen's. Supplementation of 400 daily IU, is physiologically sounder as it oromotes grow'h, avoids risk of intoxication and potentia : of tra^sien* induced hypertension cr this age. Local r ecorrmendaiions favoring vr D megadoses for rickets prevention s~cUd be revised.(Keywords: bone metcboism, vitamin D, i-fant, growln, arte'icl -ypertension.)La forma activa dc la vitamina D (vit D), la 1-25 dihidroxi vit D (L25 OH 2 vit D), participa como una hormona en la regulacion del metabolismo del calcio y f6sforo. La cantidad ncccsaria para alcanzar la funcion fisiologica optima en el lactante depende de numcrosos factores como edad, ritmo de crecimiento, absorcion intestinal, enfermcdades coexistentes y clima 1 .Los requerimientos dc vit D durante el primer ano de vida sc cstiman entre 100 y 400 UI diarias 2 --7 . La leche materna aporta aproximada-
A nalionol survey on chronic renal failure (CRF) in children was carried out by year 1994 by the branch of Neohroiogy of the Chilean Pedicrric Society, and 194 patients with CR" were recorded la prevalence of 39.6 per million inhabitants 1 8 years of age or less), 70.3% lived at Santiago, the capita city of the country, 54% were female, 63.4% we r e older than ;0 years and 2.3% were under 2 years or age. The most frequent causes of renal failure were urnar/ tract obstructions (1 8.6%j, glomeruiar aiseases (1 8%) and renal disease secondary to urinary reflux [ 1 7.5%). At the time of report, 57.2% of cases were under medical (no-diaiylic) management, 16.5/= were in a dialysis program and orly 26.3% had been given a renal 'ransp:a~t. Perito"eal procedures were usec in only 7 (3,6%) of 32 patients in dialysis., in contrast to othe 1 " countries where they are by fcr the prefered methods for children less than 20 ka weignt. Among renal t'ansplant patients, 57% were repartee to be m ccod renal fjnction end only 10% were back on analysis. Of 2 1 chi dren less then five years old, only one was on dialysis and no one had oeen g'ven a rena transplant.
ResumenInvestigaciones recientes revelan que el origen de lo hipertension arterial (HTA), grave problema de salud del adulto, estaria en la edad infan-il. El prirrer deber del pediatra cons'ste en meaV una vez a. afio la presion arterial (PA],, en condiciones oasales e interpretarla adecuadamente. Detectada 'a HTA, educar a la farrilia oara cambiar esti os de vida: reduce ion de peso en obesos, disminucio" e~ ingesta de sal y grascs saturadas, fonento del ejercicio fisico. El hioertenso debe ser referido cl especialista, quien buscarc ccusas secundarias de HTA e hdicara ccrreccion quirurgica Ique en algunos ccsos logra la curacion) o inicia'6 tratarriento farmacolocico. La responsabilidad del pediatra es aim mayor co^ la poblacion de nines normotensos. En ellos debe buscar factores de riesgo: ba[o peso de nacimiento.. relacion 'nversa en-re peso de nccimiento, peso placenlario, resistencia a la hsJina, historic "amiliar de HTA. o enfermedad cardiovascular. En esta poblacion, numericame-te superio-, la accion preventive log-arc cambios significativos en el perfil de morbimortalidad de estc patclogia en el cdultc.Palabras clave: hioertension, presion arterial en pediatria, factores de riesgo.j Children hypertension, a new insight. Responsibility of the pediatricianmeasured under basa^ conditions one readings correctly assessed. Once AHT is detected, the whoie fcmily group must jncerstand t~.e need ; or a change in li : e style: weight reduction in the obese, iow salt intake, low saturated fats in the die', promotion of regular exercise. The hypertensive child should be referred to a nephrclogist., we will seek seccncary causes, crd prescribe surgical cc r rection or pharmacological management. The pediatrician has an even g r eater responsabilify towards the ncrmotensive population, which far outnumbers that with elevated BP. He should look for risk factors such as low birth weight, placen'al/b'rth weight disparity, insulin resistance, family history of AHT or cardiovascular d ; seases. Preventive action laken in this segment of the population is most likely to bring aoout significant changes : n the morbidity and mortality profile of hypertension in the acult.[Key words hypertension, ped'ctric blooc pressure, risk fcctors.)
Blood pressure by Doppler method in 0 to 24 months old infants.Systolic blood pressure (SBP) was measured by Doppler method in an aleatory sample of 251 healthy children from south-east Santiago Chile (131 females and 120 males) which were divided by age in five groups: 0 to 28 days (n = 5) 1 to 5 months (n = 48), 6 to 11 months (n = 48), 12 to 17 months (n = 46) and 18 to 24 months (n = 45). clones directas. El uso pediatrico de la te"cnica del Doppler fue sugerido, en 1968, por Stegall 3 . La tecnica esta basada en el principio de Doppler, esto es> el cambio de frecuencia que experimenta una onda de ultrasonido a ser reflejada por los corpusculos que se desplazan dentro del vaso sangirineo 4 ' 5 .El proposito de este estudio es establecer, con este m^todo, el rango de presumes sistolicas de recie"n nacidos y lactantes normales con sus percentiles, p5, p50 y p95 y compararlas con las
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