A successful therapy of renovascular hypertension.

Authors describe a rare cause, diagnostic difficulties and successful therapy of renovascular hypertension in a 12 year-old girl caused by anular stenosis of the intrarenal arterial branch. Activation of the system renin-angiotensin (RAS) is found in all forms of renovascular hypertension at the beginning. Etiologically, stenosis in childhood is caused mostly by renal artery dysplasia, affecting mostly media, and fibromuscular dysplasia. Fibromuscular dysplasia affects middle and distal third of renal artery in 60%, more frequently on right, only in 10% of cases affects segmental branches; one quarter of patients are affected bilaterally. This disease is found predominantly in young women. During clinical course, typical signs include sudden onset of severe and poorly controlled hypertension, renal insufficiency, proteinuria and hypertensive retinopathy. From non-invasive diagnostic approaches, color duplex ultrasound, NMR and CT angiography are important, from invasive ones, digital subtractive angiography and the measurement of plasma rennin activity in renal veins. In therapy, it is percutaneous transluminal renal angioplasty, associated with low mortality and morbidity. The net result of angioplasty is dilation of stenosis, complete restoration of artery lumen and flow and decrease of blood pressure. The best results can be achieved in young patients with fibromuscular dysplasia, more then half can recover completely. Using this method, also our patient has recovered (Tab. 2, Fig. 2, Ref. 7).

[Abdominal pain in childhood caused by stenosis of the pyelo-ureteral junction]. / Bolesti brucha v detskom veku spôsobené stenózou pyeloureterálnej junkcie.

The authors describe three patients with episodes of abdominal pain where despite a negative finding in the urine sonography revealed dilatation of the hollow system. Urography proved stenosis of the pyeloureteral junction. The authors discuss the cause of abdominal pain. Consistent with data in the literature, the authors draw attention to pitfalls in the diagnosis of hydronephrosis. They recommend sonographic examination of children with abdominal pain, as a negative urinary finding does not rule out hydronephrosis. In this respect screening of hydronephrosis and other obstructive anomalies during the neonatal period is an advantage.

[Hyperechogenic renal pyramids in children]. / Hyperechogénne renálne pyramídy u detí.

The authors describe the case-histories of four children with hyperechogenic renal pyramids. These children are followed up at the First Paediatric Clinic in Bratislava.