Modified Renal Autotransplantation in Children with Renovascular Hypertension
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Hypertension in children is often associated with impaired blood flow through the kidneys as a result of the strictures of main trunks of renal arteries. Kidney autotransplantation with kidney implantation into iliac vessels is well recognized treatment for hypertension and arterial nephropathy in children, especially in cases involving complex reconstruction of arteries, or the need of reimplantation of artery outside the pathologically changed aorta.The aim of the study was to compare a group of children operated using classic and modified kidney autotransplantation technique with rotation of the kidney by 180 degrees.Material and methods. For the first time we performed such operation in 2001 in order to obtain favorable arrangement of anastomosed vessels and to avoid the need of shortening and anastomosing of the urether. In patients requiring reconstruction of arteries in the "back table" we usually used the classic method, but in cases with difficulty in matching short vessels, the modified technique was used even after "ex-situ" reconstructions.The subject of the report are 11 children aged from 8 years to 17 years in which we performed a modified kidneys autotransplantation with its rotation. In retrospective analysis we observed: function of operated kidney, occurrence of postoperative complications, need for reoperations or other vascular or urological interventions, degree of normalization of blood pressure.Results. During post operative observation we found no difference in the amount of vascular complications between the two groups. We observed difference in the occurrence of urological complications for the benefit of the group after the rotation of transplanted kidneys. At the same time using this method of operation, we obtained normalization of blood pressure and the possibility of significant reduction or discontinuation of pharmacological treatment. In all patients, we observe normal function of transplanted kidneys, except for one that was removed.Conclusions. Modified method of kidney transplantation with rotation seems to be a good and effective method of treatment in cases of difficulties with vascular and urethral matching. It is safe, reducing urological complications, alternative for classical operations.
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8 - 9 - 2009
- Sorof JM, Lai D, Turner J et al.: Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 2004; 113: 475-82.
- Joint National Committee. The fifth report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. Arch Intern Med 1993; 153: 154-83.
- Falkner B, Sadowski RH: Hypertension in children and adolescens. Am J Hypertens 1995; 8: 106S-108S.[Crossref]
- Bartosh SM, Aronson AJ: Childhood hypertension: an update on etiology, diagnosis, and treatment. Pediatr Clin North Am 1999; 46: 235-52.
- Dillon ML: The diagnosis of renovascular disease. Pediatr Nephrol 1997; 11: 366.
- Hiner LB, Falkner B: Renovascular hypertension in children. Pediatr North Am 1993; 40: 123.
- Wieteska-Klimczak A, Januszewicz P: Nadciśnienie naczyniowo-nerkowe u dzieci. W: Nadciśnienie naczyniowo-nerkowe (Januszewicz A, Szmidt J red). PWN, Warszawa 1995; 208.
- Deal JE et al.: Renovascular disease in childhood. J Pediatr 1992; 121: 378.
- Guzetta PC, Davis CF, Ruley EJ: Experience with bilateral renal artery stenosis as a cause of hypertension in childhood. J Pediatr Surg 1991; 26: 532-34.[Crossref]
- Leadbetter WF, Burkland CE: Hypertension in unilateral renal disease. J Urol 1938; 39: 611-26.
- Freeman NE, Leeds FH, Elliott WG et al.: Thrombendartherectomy for hypertension due to renal artery occlusion. JAMA 1954; 156: 1077-79.
- Stanley JC: Surgical Treatment of renovascular hypertension. Am J Surg 1997; 174: 102-10.
- Berkowitz HD, O'Neill JA Jr: Renovascular hypertension in children: surgical repair with special reference to the use of reinforced vein grafts. J Vasc Surg 1989; 9: 46-55.[PubMed]
- Stanley JC, Zelenock GB, Messina LM et al.: Pediatric renovascular hypertension: a thirty-year experience of operative treatment. J Vasc Surg 1995; 21: 212-27.
- Novic AC, Straffon RA, Stewart BH et al.: Surgical treatment of renovascular hypertension in the pediatric patient. J Urol 1982; 119: 694-53.
- Stoney RJ, Cooke PA, String ST: Surgical Treatment of renovascular hypertension in children. J Pediatr Surg 1975; 10: 631-39.[PubMed][Crossref]
- Cambria RP, Brewster DC, L'Italien G et al.: Simultaneus aortic and renal artery reconstruction: evolution of an eighteen-year experience. J Vasc Surg 1995; 21: 916-25.
- Merguergian PA, McLorie GA, Balfe JW et al.: Renal autotransplantation in children: a successful treatment for renovascular hypertension. J Urol 1990; 144: 1443-45.
- Van Bockel JH, van den Akker PJ, Chang PC et al.: Extracorporeal renal artery reconstruction for renovascular hypertension. J Vasc Surg 1991; 13: 101-11.
- Kaliciński P, Drewniak T, Kamiński A et al.: Transplantation of kidneys with vascular anomalies or harvesting injury into pediatric recipients. Transplant Proc 1996; 28(6): 3463-65.[PubMed]
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