Management of Hypertension in CAKUT: Protective Factor for CKD

Abstract

Patients with congenital kidney and urinary tract abnormalities (CAKUT) will often develop end-stage renal disease at some point and the need for renal replacement therapy is associated with high rates of morbidity and mortality. Hence, efforts to slow the progression of the disease are essential. Hypertension has been proven to be an independent risk factor for faster decline of glomerular filtration rate in renal patients, but studies involving only children with CAKUT are scarce. We performed a literature review to explore the association of hypertension with faster chronic kidney disease progression in children with CAKUT and also treatment options in this condition. A recent study reported an annual decline in GFR of 1.8 ml/min/1.73 m 2 among hypertensive patients with non-glomerular CKD, compared with 0.8 ml/min/1.73 m 2 in normotensive children. A multicenter prospective cohort in Brazil showed that a 1-unit increase in systolic blood pressure Z-score was associated with a 1.5-fold higher risk of disease progression. Since renin-angiotensin-aldosterone system activation is the most important mechanism of hypertension in these children, the first-line therapy involves the use of inhibitors of this axis, including angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers type I, which also promote an anti-fibrotic effect. Recent studies have shown a good safety profile for use in patients with chronic kidney disease and also in those with solitary kidneys. Hypertension is an independent risk factor for kidney disease progression and should be promptly managed for renal protection, especially among patients with CAKUT, the primary cause of chronic kidney disease in the pediatric population.

Association Between Metabolic Associated Fatty Liver Disease and Chronic Kidney Disease: A Cross-Sectional Study from NHANES 2017–2018

“…Hypertension is another concerning public health problem, which is an independently associated factor for CKD in all investigated subjects, but not in sub-group of DM subjects without MAFLD. As hypertension is a common disease affecting almost all human systems, and a leading cause of CKD, [28][29][30] the risk in the subgroup might have been eliminated by other factors, such as diabetes, hyperuricemia, being overweight.…”

Risk stratification for children with a solitary functioning kidney

“…Modifiable risk factors, such as obesity, smoking, or diabetes, should be avoided as much as possible because of their associations with hypertension, albuminuria, and kidney function deterioration [11,23,24,27]. For diabetes, hypertension, and cardiovascular disease, a direct relation with faster development of CKD was shown in patients with SFK [18,28,29].…”

Суточный Профиль Артериального Давления У Детей С Хроническим Пиелонефритом И Хронической Болезнью Почек I–III Стадии

“…A number of studies have shown that high BP plays the role of an independent risk factor for rapid reduction in glomerular filtration rate (GFR) in patients with renal diseases [6][7][8][9]. BP monitoring is important for the management of patients with CKD, both for the conventional cardiovascular risk reduction and long-term preservation of kidney function [8]. The parameters of 24-hour ambulatory blood pressure monitoring (ABPM) have more pronounced predictive value for the diagnosis of target organ damage than…”

“…Оригінальні статті / Original Articles the indicators determined at a single office/home BP measurement [8,10].…”

“…Normal BP values assessed by a single office measurement cannot rule out masked arterial hypertension (AH), night-time hypertension and other deviations from the norm in children with CKD [8,10]. 2017 American Academy of Pediatrics Guidance recommends the 24-hour ABPM for children and adolescents with CKD, regardless of routine office BP measurements, at least once a year [8,11].…”