Single-Dose Captopril Scintigraphy in the Neonate with Renovascular Hypertension: Prediction of Renal Failure, a Side Effect of Captopril Therapy

Sfakianakis, George N.; Sfakianaki, Efrosyni; Paredes, Abraham; Abitbol, Carolyn; Zilleruelo, Gastón; Goldberg, Robert N.; Strauss, José

doi:10.1159/000242859

Cited by 7 publications

(9 citation statements)

References 8 publications

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“…In infants, preliminary data from our center indicated that by showing the effect of a single dose of ACE inhibitors on the function of ischemic kidney(s), ACE inhibition scintigraphy can predict the potential side effects of the therapeutic use of ACE inhibitors in neonatal hypertension [8]. The retrospective review reported here provided further evidence to support this conclusion.…”

Section: Discussionsupporting

confidence: 61%

“…Based on previous experience [8,18], two criteria were considered diagnostic of RVH. Criterion I comprised a non-functioning kidney on baseline studies.…”

Section: Criteria For Diagnosis Of Rvh By Scintirenographymentioning

confidence: 99%

“…In the neonate, umbilical artery catheterization poses a risk for the development of renal ischemia, which may be transient from inappropriate placement of the catheter, or persistent from complicating aortic and renal artery thrombi. Although the affected kidney may escape permanent damage, when ischemia is severe there could be infarction, involution, or arrested kidney growth with persistence of hypertension requiring nephrectomy [5][6][7][8]. In the older child, RVH is usually due to stenosis or aneurysm of the main renal artery or its branches, and is potentially curable.…”

Section: Introductionmentioning

confidence: 99%

“…Scintigraphic provocative studies based on the effect of angiotensin converting enzyme (ACE) inhibitors on renal function have been successfully used for the diagnosis of renal ischemia and RVH in adults and in a limited number of children for more than a decade [8,[13][14][15][16][17][18][19]. This report constitutes our experience with ACE inhibition scintigraphy in 57 hypertensive children.…”

Section: Introductionmentioning

confidence: 99%

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ACE inhibition scintigraphy in the management of hypertension in children

Chandar

Sfakianakis

Zilleruelo

et al. 1999

Pediatric Nephrology

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Angiotensin converting enzyme (ACE) inhibition scintirenography was performed to help establish the diagnosis and plan treatment of renovascular hypertension (RVH) in 57 hypertensive pediatric patients, 33 infants and 24 children older than 1 year. In 16 of 33 hypertensive infants, ACE inhibition scintirenography established the diagnosis of RVH from renal ischemia (due to aortic or renal arterial thrombi). Two scintigraphic criteria were used for the diagnosis of RVH: criterion I, ischemic and damaged kidney (a non-functioning kidney on or off ACE inhibition) and criterion II, ischemic but not damaged kidney (ACE inhibition induced deterioration of function of the kidney). When criterion I was present and the contralateral kidney was normal, ACE inhibitors could be used for treatment of hypertension without deterioration of renal function; kidneys satisfying criterion I eventually involuted or manifested growth arrest and frequently caused persistent RVH, even after resolution of the thrombus, requiring nephrectomy. When criterion II was present bilaterally, or it was associated with criterion I contralaterally, the use of antihypertensive drugs other than ACE inhibitors was necessary in order to prevent renal insufficiency or failure from ACE inhibitors. However, kidneys with criterion II showed normal growth and, following retraction or dissolution of the aortic thrombus, hypertension resolved. In 2 of 24 hypertensive children older than 1 year, the test was diagnostic of branch renal artery stenosis; RVH was cured by selective angioplasty. ACE inhibition scintirenography is useful in the evaluation and planning of treatment in children with hypertension and may predict the outcome of therapy and ultimate renal function.

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Section: Discussionsupporting

confidence: 61%

“…Based on previous experience [8,18], two criteria were considered diagnostic of RVH. Criterion I comprised a non-functioning kidney on baseline studies.…”

Section: Criteria For Diagnosis Of Rvh By Scintirenographymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

ACE inhibition scintigraphy in the management of hypertension in children

Chandar

Sfakianakis

Zilleruelo

et al. 1999

Pediatric Nephrology

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“…An ACE inhibitor may be used in the absence of bilateral renovascular disease or a solitary kidney [81]. However, ACE inhibitors should be avoided or used with extreme caution in neonates with renovascular hypertension due to the risk of renal failure [82]. Moreover, plasma creatinine may be normal, and subtle deterioration in the renal function of the uninvolved contralateral kidney may be evident only by renal scintigraphy [81].…”

Section: Management Of Hypertensive Urgencymentioning

confidence: 99%

Hypertensive crisis in children

Chandar

Zilleruelo

2011

Pediatr Nephrol

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Hypertensive crisis is rare in children and is usually secondary to an underlying disease. There is strong evidence that the renin-angiotensin system plays an important role in the genesis of hypertensive crisis. An important principle in the management of children with hypertensive crisis is to determine if severe hypertension is chronic, acute, or acute-on-chronic. When it is associated with signs of end-organ damage such as encephalopathy, congestive cardiac failure or renal failure, there is an emergent need to lower blood pressures to 25-30% of the original value and then accomplish a gradual reduction in blood pressure. Precipitous drops in blood pressure can result in impairment of perfusion of vital organs. Medications commonly used to treat hypertensive crisis in children are nicardipine, labetalol and sodium nitroprusside. In this review, we discuss the pathophysiology, differential diagnosis and recent developments in management of hypertensive crisis in children.

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