Tumor de células yuxtaglomerulares (reninoma) como causa de hipertensión arterial en la adolescencia. A propósito de un caso / Juxtaglomerular cell tumor (reninoma) as a cause of arterial hypertension in adolescents. A case report

La hipertensión arterial (HTA) grave en pediatría responde fundamentalmente a causas secundarias. Presentamos una paciente adolescente de 14 años con HTA grave, alcalosis metabólica e hipopotasemia, secundaria a un tumor de células yuxtaglomerulares productor de renina, diagnosticado luego de dos años de evolución de HTA.

Severe arterial hypertension (HTN) in pediatrics is mainly due to secondary causes. Here we describe the case of a 14-year-old female adolescent with severe HTN, metabolic alkalosis, and hypokalemia, secondary to a renin-secreting juxtaglomerular cell tumor diagnosed after 2 years of HTN progression.

Embolia por colesterol en miembros inferiores: reporte de caso

La embolia por cristales de colesterol es efecto de la desestabilización de una placa de ateroma tras un evento desencadenante, produciendo la migración de cristales de colesterol hasta arteriolas periféricas, desencadenando un proceso inflamatorio endotelial; el espectro clínico varía desde ser asintomático hasta con un compromiso multiorgánico; la sospecha diagnóstica es principalmente clínica y será la biopsia de piel por su fácil accesibilidad, la que confirme el diagnóstico. El tratamiento es aún controvertido y no existe un consenso de las medidas terapéuticas para aplicar. A continuación, se presenta el caso de un paciente varón de 72 años de edad con una ateroembolia por cristales de colesterol en miembros inferiores, secundaria a una manipulación endovascular por angioplastia previa.

Cholesterol crystal embolism is the effect of the destabilization of an atherosclerotic plaque after a triggering event, producing the migration of cholesterol crystals to peripheral arterioles, triggering an endothelial inflammatory process; the clinical spectrum varies from being asymptomatic to having multiple organ involvement; diagnostic suspicion is mainly clinical and the skin biopsy will confirm the diagnosis due to its easy accessibility. The treatment is still controversial and there is no consensus on the therapeutic measures to apply. Below is the case of a 72-year-old male patient with atheroembolism due to cholesterol crystals in the lower limbs, secondary to endovascular manipulation by prior angioplasty.

Takayasu arteritis associated with focal and segmentary glomerulosclerosis

Takayasu arteritis (TA) is a large vessel vasculitis that affects young people, related to cardiovascular outcomes and chronic kidney disease. We present the case of a 20-year-old male with a diagnosis of TA, who developed chronic kidney disease, impaired renal blood flow was ruled out, renal biopsy was compatible with focal and segmental glomerulosclerosis of a collapsing variety, other possible aetiologies were excluded. The mechanisms that mediate this association have not been determined, immune-mediated mechanisms are proposed. According to our review, this is the second reported case of this association and the first with a collapsing variety.

La arteritis de Takayasu es una vasculitis de grandes vasos que afecta a personas jóvenes y se relaciona con desenlaces cardiovasculares y enfermedad renal crónica. Se presenta el caso de un paciente masculino de 20 arios, con diagnóstico de arteritis de Takayasu, que desarrolla enfermedad renal crónica. Se descartan alteraciones en el flujo sanguíneo renal, en tanto que la biopsia renal resulta compatible con glomeruloesclerosis focal y segmentaria de variedad colapsante. Se excluyeron otras posibles etiologías. No se han determinado los mecanismos que median en esta asociación; se proponen mecanismos inmunomediados. Según nuestra revisión, se trata del segundo caso reportado de esta asociación y el primero con variedad colapsante.

Hipertensão renovascular levando à nefrectomia unilateral: relato de caso / Renovascular hypertension leading to unilateral nephrectomy: case report

Objetivo: Relatar o caso de uma paciente jovem portadora de Hipertensão Arterial Secundária à estenose da artéria renal, que evoluiu com perda renal em decorrência de necessidade de nefrectomia unilateral, enfatizado a importância do diagnóstico e da abordagem adequada desta patologia para o controle da pressão arterial e preservação da função renal. Método: Os dados foram obtidos através de entrevista com a paciente, análise de prontuário, laudos de técnicas diagnósticas, as quais a paciente foi submetida, entre julho e novembro de 2019, durante as consultas médicas e revisão bibliográfica. Conclusão: A nefrectomia unilateral mostrou-se eficaz no controle da hipertensão arterial, na melhora do desempenho renal, possibilitando a melhoria na qualidade de vida do indivíduo afetado

Objective: To report the case of a young patient with SAH secondary to renal artery stenosis, who developed renal loss due to the need for unilateral nephrectomy, emphasizing the importance of the diagnosis and the appropriate approach of this pathology for the control of blood pressure and preservation of renal function. Method: The data were obtained through interview with the patient, analysis of medical records, reports of diagnostic techniques, which the patient was submitted between July and November 2019, during medical consultations and literature review. Conclusion: Unilateral Nephrectomy proved to be effective in controlling arterial hypertension, improving renal performance and in the evolution of renal insufficiency that is difficult to control from the renovascular root, enabling improvement in the affected individual's quality of life

Environmental Enrichment Promotes Antioxidant Effect in the Ventrolateral Medulla and Kidney of Renovascular Hypertensive Rats / O Enriquecimento Ambiental Promove Efeito Antioxidante no Bulbo Ventrolateral e Rins de Roedores com Hipertensão Renovascular

Abstract Background: Arterial hypertension is a precursor to the development of heart and renal failure, furthermore is associated with elevated oxidative markers. Environmental enrichment of rodents increases performance in memory tasks, also appears to exert an antioxidant effect in the hippocampus of normotensive rats. Objectives: Evaluate the effect of environmental enrichment on oxidative stress in the ventrolateral medulla, heart, and kidneys of renovascular hypertensive rats. Methods: Forty male Fischer rats (6 weeks old) were divided into four groups: normotensive standard condition (Sham-St), normotensive enriched environment (Sham-EE), hypertensive standard condition (2K1C-St), and hypertensive enriched environment (2K1C-EE). Animals were kept in enriched or standard cages for four weeks after all animals were euthanized. The level of significance was at p < 0.05. Results: 2K1C-St group presented higher mean arterial pressure (mmHg) 147.0 (122.0; 187.0) compared to Sham-St 101.0 (94.0; 109.0) and Sham-EE 106.0 (90.8; 117.8). Ventrolateral medulla from 2K1C-EE had higher superoxide dismutase (SOD) (49.1 ± 7.9 U/mg ptn) and catalase activity (0.8 ± 0.4 U/mg ptn) compared to SOD (24.1 ± 9.8 U/mg ptn) and catalase activity (0.3 ± 0.1 U/mg ptn) in 2K1C-St. 2K1C-EE presented lower lipid oxidation (0.39 ± 0.06 nmol/mg ptn) than 2K1C-St (0.53 ± 0.22 nmol/mg ptn) in ventrolateral medulla. Furthermore, the kidneys of 2K1C-EE (11.9 ± 2.3 U/mg ptn) animals presented higher superoxide-dismutase activity than those of 2K1C-St animals (9.1 ± 2.3 U/mg ptn). Conclusion: Environmental enrichment induced an antioxidant effect in the ventrolateral medulla and kidneys that contributes to reducing oxidative damage among hypertensive rats.

Resumo Fundamento: A hipertensão arterial é um precursor para o desenvolvimento da insuficiência cardíaca e renal e, além disso, está associada com o aumento dos marcadores oxidativos. O enriquecimento ambiental dos roedores melhora o desempenho em tarefas de memória, e também parece ter um efeito antioxidante sobre o hipocampo dos ratos normotensos. Objetivos: Avaliar o efeito do enriquecimento ambiental sobre o estresse oxidativo no bulbo ventrolateral, coração, e rins de ratos com hipertensão renovascular. Métodos: Quarenta ratos machos, tipo Fischer (6 semanas de idade), foram divididos em quatro grupos: normotensos em condições padrão (Sham-CP), normotensos em ambiente enriquecido (Sham-AE), hipertensos em condições padrão (2R1C-CP), e hipertensos em ambiente enriquecido (2R1C-AE). Os animais foram mantidos em gaiolas enriquecidas ou padrão durante quatro semanas e, por fim, todos os animais foram eutanasiados. O nível de significância foi p < 0,05. Resultados: O grupo 2R1C-CP apresentou pressão arterial média maior (mmHg) 147,0 (122,0; 187,0) quando comparado com os grupos Sham-CP 101,0 (94,0; 109,0) e Sham-AE 106,0 (90,8; 117,8). Observou-se maior atividade das enzimas superóxido dismutase (SOD) (49,1 ± 7,9 U/mg ptn) e da catalase (0,8 ± 0,4 U/mg ptn) no bulbo ventrolateral do grupo 2R1C-AE, em relação à atividade da SOD (24,1 ± 9,8 U/mg ptn) e da catalase (0,3 ± 0,1 U/mg ptn) no grupo 2R1C-CP. No grupo 2R1C-AE, a oxidação lipídica no bulbo ventrolateral foi menor (0,39 ± 0,06 nmol/mg ptn) quando comparado com o grupo 2R1C-CP (0,53 ± 0,22 nmol/mg ptn). Ademais, foi observada maior atividade das enzimas superóxido dismutase nos rins dos animais 2R1C-AE (11,9 ± 2,3 U/mg ptn) em relação aos animais 2R1C-CP (9,1 ± 2,3 U/mg ptn). Conclusão: O enriquecimento ambiental provocou efeito antioxidante no bulbo ventrolateral e nos rins, o que contribuiu para a redução do dano oxidante nos ratos hipertensos.

Diagnosis and management of renovascular hypertension in children / 中华实用儿科临床杂志

Renovascular hypertension accounts for 5%-10% of hypertension in children, which is usually di-fficult to control by medicine and leads to severe clinical complications.However, it is potentially amenable to curative treatment.Clinical early recognition and proper treatment might not only effectively control hypertension, but also preserve renal blood supply and renal function, which is of great significance for the long-term prognosis in children.In this review, the author provide current knowledge of renovascular hypertension in children, including its cause, pathogenesis, diagnostic method, and medical, interventional, and surgical treatment.

Value of the Filtration Fraction Assessed by Dynamic ⁹⁹mTc-Diethylenetriaminepentaacetic Acid Renal Scintigraphy After Angiotensin-Converting Enzyme Inhibition for the Diagnosis of Renovascular Hypertension / 대한핵의학회잡지

PURPOSE: This study aimed to determine the diagnostic value of the relative filtration fraction (RFF) assessed by dynamic ⁹⁹mTc-diethylenetriaminepentaacetic acid (⁹⁹mTc-DTPA) renal scintigraphy after angiotensin-converting enzyme (ACE) inhibition for renovascular hypertension (RVHT) diagnosis.METHODS: ⁹⁹mTc-DTPA captopril renal scintigraphy performed in adolescents or adults (≥ 10 years) with suspected RVHT was retrospectively reviewed. The RFF of the affected kidney was qualitatively assessed as the relative glomerular filtration rate during the 2 to 3-min period compared with the relative perfusion during the first 60 s (qualitative RFF) and scored from 1 (definitely same) to 5 (definitely decreased). The quantitative RFF of the affected kidney was obtained by dividing the percentage of glomerular filtration rate by the percentage of renal perfusion.RESULTS: Overall, 173 patients (high probability, n = 15; and low probability, n = 158) were included based on conventional captopril renal scintigraphic criteria. An abnormal qualitative RFF was observed in 12 patients with high probability, and the diagnostic sensitivity was 80.0% (95% CI, 51.9–95.7). The RFF was normal in 152 patients with low probability, and the diagnostic specificity was 96.2% (95% CI, 91.9–98.6). The RFF was lower in patients with high probability than in those with low probability (0.79 ± 0.15 vs. 1.02 ± 0.11, P < 0.0001).CONCLUSIONS: The RFF assessed by dynamic ⁹⁹mTc-DTPA renal scintigraphy after ACE inhibition can detect patients with high probability for RVHT. The RFF after ACE inhibition might be a useful diagnostic criterion especially when baseline scintigraphy is not available for evaluating ACE inhibition-induced changes.

Diagnosis and management of renovascular hypertension in children / 中华实用儿科临床杂志

Renovascular hypertension accounts for 5％-10％ of hypertension in children,which is usually difficult to control by medicine and leads to severe clinical complications.However,it is potentially amenable to curative treatment.Clinical early recognition and proper treatment might not only effectively control hypertension,but also preserve renal blood supply and renal function,which is of great significance for the long-term prognosis in children.In this review,the author provide current knowledge of renovascular hypertension in children,including its cause,pathogenesis,diagnostic method,and medical,interventional,and surgical treatment.

Estenosis de la arteria renal unilateral de diagnóstico neonatal / Neonatal diagnosis of unilateral renal artery stenosis

La estenosis de la arteria renal es una causa rara de hipertensión arterial neonatal de origen renovascular. Hay muy pocos casos descritos en la literatura en esta etapa. La mayor parte de los pacientes con esta afectación permanecen asintomáticos, y la hipertensión se detecta en las revisiones pediátricas rutinarias. El diagnóstico puede realizarse mediante la combinación de hallazgos bioquímicos y radiológicos. El manejo inicial del paciente se basa en terapia farmacológica hasta alcanzar un crecimiento adecuado para evaluar la reparación definitiva de la lesión vascular o la nefrectomía en caso de supresión funcional del riñón afecto. Se presenta a una paciente femenina recién nacida a término, con hipertensión arterial e importante falla cardíaca congestiva, originada por una estenosis unilateral de la arteria renal, con supresión funcional y atrofia del riñón afecto, que precisó importante soporte inotrópico y antihipertensivo durante los primeros días de vida, con importante mejoría clínica posterior.

Renal artery stenosis represents a rare cause of neonatal arterial hypertension of renovascular origin, having been described few cases in the literature at this stage of life. Most patients with this disease remain asymptomatic; hypertension can be detected in routine pediatric revisions. Diagnosis can be performed by combining biochemical and radiological findings. The initial management consists of pharmacological therapy in order to achieve adequate growth. Subsequently, it is necessary to assess definitive repair of the vascular lesion or nephrectomy in the case of functional abolition of the affected kidney. We present a term newborn female, with arterial hypertension and an important congestive heart failure, caused by a unilateral renal artery stenosis, with functional abolition and atrophy of the affected kidney, which required an important inotropic and antihypertensive support during her first days of life, with significant clinical improvement subsequently.

Renovascular hypertension secondary to congenital hypoplasia of renal arteries in middle adult patient. About a case / Hipertensión renovascular secundaria a hipoplasia congénita de arterias renales en un paciente adulto joven. A propósito de un caso

Abstract The tubular hypotrophy of the renal arteries constitutes a rare clinical entity, that is associated with the appearance of renovascular hypertension. Its diagnostic approach is complex and requires the availability of angiography to determine the features of the renal vessels. The following case exemplifies the diagnostic process of a patient with this special clinical situation.

Resumen La hipotrofia de aspecto tubular de las arterias renales constituye una rara entidad clínica asociada a la aparición de hipertensión renovascular. Su enfoque diagnóstico es complejo y exige la disponibilidad de angiografía para determinar las características propias del contorno de la vasculature renal. El caso clínico considerado en este artículo ejemplifica el proceso diagnóstico de un paciente con esta particular situación.

Revascularization of Concurrent Renal and Cerebral Artery Stenosis in a 14-Year-Old Girl with Takayasu Arteritis and Moyamoya Syndrome

Concurrent involvement of bilateral renal and cerebral arteries, usually incurred as stenosis, is rare in childhood-onset Takayasu arteritis (c-TA). We report the case of a 14-year-old girl, with c-TA, presenting with transient ischemic attack after endovascular revascularization for renal artery stenosis and cerebrovascular stroke after surgical revascularization for cerebral artery stenosis associated with childhood-onset moyamoya syndrome. We deem that decrease of blood pressure by endovascular revascularization and improvement of cerebral perfusion by surgical revascularization may have jeopardized the cerebral deep watershed zone to cerebral ischemia followed by cerebral hyperperfusion syndrome and caused transient ischemic attack and cerebrovascular stroke in our patient. Revascularization could be a double-edge sword for c-TA patients presenting with concomitant renal artery stenosis and cerebral artery stenosis, and should be performed with caution. Quantitative analysis of cerebral blood flow by brain magnetic resonance imaging and angiography should be performed within 48 hours after surgical revascularization in c-TA.

Electronic protocol for clinical data collection in chronic visceral ischemia / Protocolo eletrônico de coleta de dados clínicos da isquemia visceral crônica

Abstract Patients with vascular diseases present with a long medical history which makes for complex and confusing medical records. Electronic record systems have a large storage capacity and high information processing capabilities, and may therefore improve the quality and reliability of prospective clinical studies. In the present study, a theoretical framework for clinical data collection in chronic visceral ischemia was created containing 5706 items, organized into six major categories: medical history, physical examination, laboratory testing, diagnosis, treatment and outcome. The database was used to construct an electronic data collection protocol, which was uploaded into the Integrated Electronic Protocol System (Sistema Integrado de Protocolos Eletrônicos, SINPE©) and then used to perform retrospective collection and analysis of clinical data from 10 patients using the SINPE© analysis module.

Resumo Pacientes portadores de doenças vasculares possuem histórico médico longo, o que dificulta a revisão das informações contidas nos prontuários. Protocolos eletrônicos de dados clínicos permitem grande capacidade de armazenamento e processamento de informações, otimizando a qualidade e a confiabilidade de trabalhos científicos. Neste trabalho foi criada uma base teórica para coleta de dados clínicos referentes à isquemia crônica visceral composta de 5.706 itens agrupadas sob os seguintes categorias principais: anamnese, exame físico, exames complementares, diagnóstico, tratamento e evolução. Essa base foi transformada em um protocolo eletrônico de coleta de dados, e este foi incorporado ao Sistema Integrado de Protocolos Eletrônicos (SINPE©) e utilizado para cadastrar, coletar e analisar os dados de dez pacientes através do módulo SINPE© Analisador.

Pediatric Vascular Surgery Review with a 30-Year-Experience in a Tertiary Referral Center

Pediatric vascular disease is rare, and remains a big challenge to vascular surgeons. In contrast to adults, surgery for pediatric vascular disease is complicated by issues related to small size, future growth, and availability of suitable vascular conduit. During the last 30 years, 131 major vascular operations were performed in a tertiary referral center, Seoul National University Hospital, including aortoiliac aneurysm, acute or chronic arterial occlusion, renovascular hypertension, portal venous hypertension, trauma, tumor invasion to major abdominal vessels, and others. Herein we review on the important pediatric vascular diseases and share our clinical experiences on these rare diseases.

The Labdane Ent-3-Acetoxy-Labda-8(17), 13-Dien-15-Oic Decreases Blood Pressure In Hypertensive Rats / O Labdano Ácido Ent-3-Acetóxi-Labda-8(17), 13-Dieno-15-Óico Reduz Pressão Arterial Em Ratos Hipertensos

Abstract Background: Labdane-type diterpenes induce lower blood pressure via relaxation of vascular smooth muscle; however, there are no studies describing the effects of labdanes in hypertensive rats. Objective: The present study was designed to investigate the cardiovascular actions of the labdane-type diterpene ent-3-acetoxy-labda-8(17), 13-dien-15-oic acid (labda-15-oic acid) in two-kidney 1 clip (2K-1C) renal hypertension. Methods: Vascular reactivity experiments were performed in aortic rings isolated from 2K-1C and normotensive (2K) male Wistar rats. Nitrate/nitrite (NOx) measurement was performed in aortas by colorimetric assay. Blood pressure measurements were performed in conscious rats. Results: Labda-15-oic acid (0.1-300 µmol/l) and forskolin (0.1 nmol/l - 1 µmol/l) relaxed endothelium-intact and endothelium-denuded aortas from both 2K-1C and 2K rats. Labda-15-oic acid was more effective at inducing relaxation in endothelium-intact aortas from 2K pre-contracted with phenylephrine when compared to the endothelium-denuded ones. Forskolin was more potent than labda-15-oic acid at inducing vascular relaxation in arteries from both 2K and 2K-1C rats. Labda-15-oic acid-induced increase in NOx levels was lower in arteries from 2K-1C rats when compared to 2K rats. Intravenous administration of labda-15-oic acid (0.3-3 mg/kg) or forskolin (0.1-1 mg/kg) induced hypotension in conscious 2K-1C and 2K rats. Conclusion: The present findings show that labda-15-oic acid induces vascular relaxation and hypotension in hypertensive rats.

Resumo Fundamento: Diterpenos do tipo labdano induzem uma queda da pressão arterial por meio do relaxamento do músculo liso vascular; todavia, não há estudos que descrevam os efeitos de labdanos em ratos hipertensos. Objetivo: O presente estudo foi desenvolvido para investigar as ações cardiovasculares do labdano ácido ent-3-acetóxi-labda-8(17),13-dieno-15-óico (labda-15-óico) na hipertensão renal dois rins-1 clipe (2R-1C). Métodos: Foram feitos experimentos de reatividade vascular em anéis aórticos isolados de ratos machos 2R-1C e normotensos (2R). A medição de Nitrato/Nitrito (NOx) foi feita nas aortas por meio de ensaio colorimétrico. As medidas de pressão arterial foram feitas em ratos conscientes. Resultados: O ácido labda-15-óico (0,1 - 300 µmol/l) e a forscolina (0,1 nmol/l - 1 µmol/l) relaxaram as aortas com endotélio intacto e as aortas sem endotélio dos ratos 2R-1C e 2R. O labda-15-óico mostrou-se mais eficaz na indução do relaxamento em aortas com endotélio intacto de 2R pré-contraídas com fenilefrina em comparação àquelas sem endotélio. A forscolina mostrou-se mais potente do que o ácido labda-15-óico na indução do relaxamento vascular nas artérias tanto de ratos 2R-1C quanto de ratos 2R. O aumento dos níveis de NOx induzido pelo ácido labda-15-óico foi menor nas artérias de ratos 2R-1C em comparação a ratos 2R. A administração intravenosa de ácido labda-15-óico (0,3-3 mg/kg) ou forscolina (0,1-1 mg/kg) induziu hipertensão em ratos 2R-1C e 2R conscientes. Conclusão: Os presentes resultados mostram que o labda-15-óico induz relaxamento vascular e hipotensão em ratos hipertensos.

Idiopathic midaortic syndrome with malignant hypertension in 3-year-old boy / 소아과

Midaortic syndrome (MAS) is a rare vascular disease that commonly causes renovascular hypertension. The lumen of the abdominal aorta narrows and the ostia of the branches show stenosis. MAS is associated with diminished pulses in the lower extremities compared with the upper extremities, severe hypertension with higher blood pressure in the upper rather than lower extremities, and an abdominal bruit. The clinical symptoms are variable, and recognition in children with hypertension can aid early diagnosis and optimal treatment. Hypertension with MAS is malignant and often refractory to several antihypertensive drugs. Recently, radiologic modalities have been developed and have led to numerous interventional procedures. We describe the case of a 3-year-old boy presenting with left ventricular hypertrophy whose severely elevated blood pressure led to the diagnosis of idiopathic MAS. This case highlights the importance of measuring blood pressure and conducting a detailed physical examination to diagnose MAS. This is the first reported case of idiopathic MAS diagnosed in childhood in Korea.

Pathogenetic Overlapping of Renovascular Hypertension Developed in a Child with Takayasu Arteritis: 'One-clip, One and Half-kidney Model'

There are two pathogenic models of renovascular hypertension (RVH) originating from renal artery stenosis. We noted a case of a boy who had severe hypertension with atrophic left kidney, hypertrophic right kidney, a segmental stricture of the abdominal aorta, and total occlusion of the right renal artery. Due to the atrophic change of the contralateral, unclipped left kidney, this patient presented with various clinical manifestations related to both models of pathogenesis of RVH occurring at the same time. We conclude that this patient presented with the middle stage of the two RVH pathogenetic models, so called the 'one-clip, one and half-kidney model.'

Effects of hydrogen sulfide on arterial vasodilatation function of renal hypertensive rats / 中国药理学通报

Aim To investigate the modulation effects of NaHS on arterial vasodilatation functions of renal hy-pertensive rats .Methods Two-kidney , one-c lip ( 2K1C ) renovascular hypertension was induced .Rats were randomly divided into four group:sham group , two-kidney one-clip model ( 2K1C ) group, 2KIC +NaSH( H2 S donor ) group, PPG group.The systolic blood pressure ( SBP ) was measured before the opera-tion and each week after the operation .The carotid ar-tery was collected for morphometric parameters ( outer radius, wall thickness, the radio of wall thickness to outer radius) and the tension of the carotid artery was observed with the isolated artery ring technique .Immu-nohistochemistry was used to determine the protein ex-pression of eNOS , ET-1 protein in carotid artery .Re-sults The blood pressure of 2K1C group and PPG group was higher than that of sham group ( P<0.05) . Compared with 2K1C group,the blood pressure and the rat arteria carotis communis of the radio of wall thick-ness to outer radius of 2K1C+NaHS group decreased significantly , while the relaxation of carotid artery to ACh in NaHS group increased .According to the immu-nohistochemistry results , eNOS expression was upregu-lated while ET-1 was downregulated in 2K1C +NaHS group as compared with 2K1C group.Conclusions Chronical administration of NaHS can decrease blood pressure in renovasocular hypertensive rats .The anti-hypertensive effect of H 2 S maybe associated with im-provement of the arterial functions .

Time-course effects of aerobic exercise training on cardiovascular and renal parameters in 2K1C renovascular hypertensive rats

Exercise training (Ex) has been recommended for its beneficial effects in hypertensive states. The present study evaluated the time-course effects of Ex without workload on mean arterial pressure (MAP), reflex bradycardia, cardiac and renal histology, and oxidative stress in two-kidney, one-clip (2K1C) hypertensive rats. Male Fischer rats (10 weeks old; 150–180 g) underwent surgery (2K1C or SHAM) and were subsequently divided into a sedentary (SED) group and Ex group (swimming 1 h/day, 5 days/week for 2, 4, 6, 8, or 10 weeks). Until week 4, Ex decreased MAP, increased reflex bradycardia, prevented concentric hypertrophy, reduced collagen deposition in the myocardium and kidneys, decreased the level of thiobarbituric acid-reactive substances (TBARS) in the left ventricle, and increased the catalase (CAT) activity in the left ventricle and both kidneys. From week 6 to week 10, however, MAP and reflex bradycardia in 2K1C Ex rats became similar to those in 2K1C SED rats. Ex effectively reduced heart rate and prevented collagen deposition in the heart and both kidneys up to week 10, and restored the level of TBARS in the left ventricle and clipped kidney and the CAT activity in both kidneys until week 8. Ex without workload for 10 weeks in 2K1C rats provided distinct beneficial effects. The early effects of Ex on cardiovascular function included reversing MAP and reflex bradycardia. The later effects of Ex included preventing structural alterations in the heart and kidney by decreasing oxidative stress and reducing injuries in these organs during hypertension.

Revascularización percutánea en hipertensión renovascular: reporte de un caso clínico y revisión de la literatura / Percutaneous revascularization in renovascular hypertension: clinical case report and literature review

Introducción de caso: presentamos el caso de un varón de 63 años con diagnóstico de estenosis renal severa unilateral, hipertensión renovascular, con fracaso del tratamiento clínico y evidencia de insuficiencia renal inicial, quien fue sometido a angioplastia y colocación de Stent en el tercio proximal de arterial renal derecha, sin complicaciones y con adecuado flujo distal. Las cifras tensionales en el post procedimiento inmediato y luego de un año, demuestran adecuado control con dos fármacos y los valores séricos muestran normalización de la función renal. La estenosis de la arterial renal representa la primera causa de hipertensión secundaria, se relaciona con altas tasas de desenlaces cardiovasculares adversos, por cuanto su sospecha e identificación es importante. Varias técnicas de imagen permiten confirmar la impresión diagnóstica, de ellas se destaca el ultrasonido doppler de arterias renales, la angiotomografía y la angiografía selectiva. Conclusiones: el tratamiento de estos pacientes se encuentra aún en discusión y la evidencia actual indica que el manejo clínico presenta iguales desenlaces en términos de morbimortalidad comparado con la revascularización percutánea, sin embargo críticas en relación al diseño de los estudios impiden que haya un consenso sobre este tema a nivel mundial.

Case presentation: we report the case of a 63 year-old male with unilateral severe renal artery stenosis diagnosis, renal vascular hypertension, with clinical treatment failure and evidence of initial renal failure, who underwent angioplasty and Stent implantation in the third proximal of the renal right artery, without complications and adequate distal fow. Blood pressure control improved immediately after procedure and one year after adequate control is achieved with two medications and serum values for renal function are normal. Renal artery stenosis is the leading cause of secondary hypertension, and it is related with high rates of adverse cardiovascular consequences; which is why its suspicion and identifcation is important. Several imaging techniques are used to confrm the diagnosis; Doppler ultrasound, angio CT and selective angiography are the most used. Conclusions: current evidence shows that clinical management is the most adequate therapy in these cases, however there is much criticism about recent trials design. A larger, unbiased trial is needed in order to reach a general consensus worldwide.