PEDIATRIC HYPERTENSION - THE ROLE OF THE GENERAL PRACTITIONER IN HIGHLIGHTING A SILENT DISEASE
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.58043/rphrc.52 |
Resumo: | Blood Pressure (BP) assessment within Primary Health Care (CSP) surveillance consultations results from the recognition of a growing importance of Hypertension (HTN) problematic at a young age. Hypertension is defined by systolic and / or diastolic BP above the 95th percentile (P). Secondary hypertension is more frequent in pre-adolescent children and the main etiology are renal causes. Due to treatable cause of hypertension, early diagnosis and treatment are essential. We present a case of an asymptomatic pre-adolescent (12 years old), who, in the CSP surveillance consultation presented blood pressure values of 120/70 mm Hg (systolic and diastolic TA> 5 mm Hg from P99). The personal background showed episodes of feverish urinary tract infections during the first 3 years of life; from family background, obesity, hypertension and kidney stones are highlighted . Physical examination, besides high value of BP, which was maintained in outpatient control the following days. Renal ultrasound revealed asymmetry, with globose dimensions on right kidney (RD) and smaller dimensions on left kidney (ER), irregular contours and cortical structure irregularities (sequelae of inflammatory processes ). She was referred to Pediatric Nephrology consultation, where complemented the investigation of secondary causes of HTN. The renal scintigram showed ER of reduced dimensions and with marked hypofunction (12.63%), increased dimensions on RD (87.37%) and bilateral cicatricial lesions; serial voiding cystouretrography revealed bilateral grade IV vesicourethral reflux, which was corrected. Started antihypertensive therapy with ramipril, with difficulty in tension control confirmed by ABPM. Currently being followed at Pediatric Nephrology consultation, medicated with ramipril 5 + 5 mg, cholecalciferol and oral iron. Due to treatment resistance, nephrectomy is considered. Parenchymal kidney disease is a frequent cause of child hypertension, whose prognosis depends on early treatment. This show the importance of systematic BP assessment in child health consultations. When identified, the disease must be investigated and adequately treated. |
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PEDIATRIC HYPERTENSION - THE ROLE OF THE GENERAL PRACTITIONER IN HIGHLIGHTING A SILENT DISEASEHTA EM IDADE PEDIÁTRICA – O PAPEL DO MÉDICO DE FAMÍLIA AO DAR VOZ A UMA DOENÇA SILENCIOSAHipertensão arterialHipertensão secundáriaPediatriaDoença Renal Parenquimatosaarterial hypertensionsecondary hypertensionpediatricsparenchymal kidney diseaseBlood Pressure (BP) assessment within Primary Health Care (CSP) surveillance consultations results from the recognition of a growing importance of Hypertension (HTN) problematic at a young age. Hypertension is defined by systolic and / or diastolic BP above the 95th percentile (P). Secondary hypertension is more frequent in pre-adolescent children and the main etiology are renal causes. Due to treatable cause of hypertension, early diagnosis and treatment are essential. We present a case of an asymptomatic pre-adolescent (12 years old), who, in the CSP surveillance consultation presented blood pressure values of 120/70 mm Hg (systolic and diastolic TA> 5 mm Hg from P99). The personal background showed episodes of feverish urinary tract infections during the first 3 years of life; from family background, obesity, hypertension and kidney stones are highlighted . Physical examination, besides high value of BP, which was maintained in outpatient control the following days. Renal ultrasound revealed asymmetry, with globose dimensions on right kidney (RD) and smaller dimensions on left kidney (ER), irregular contours and cortical structure irregularities (sequelae of inflammatory processes ). She was referred to Pediatric Nephrology consultation, where complemented the investigation of secondary causes of HTN. The renal scintigram showed ER of reduced dimensions and with marked hypofunction (12.63%), increased dimensions on RD (87.37%) and bilateral cicatricial lesions; serial voiding cystouretrography revealed bilateral grade IV vesicourethral reflux, which was corrected. Started antihypertensive therapy with ramipril, with difficulty in tension control confirmed by ABPM. Currently being followed at Pediatric Nephrology consultation, medicated with ramipril 5 + 5 mg, cholecalciferol and oral iron. Due to treatment resistance, nephrectomy is considered. Parenchymal kidney disease is a frequent cause of child hypertension, whose prognosis depends on early treatment. This show the importance of systematic BP assessment in child health consultations. When identified, the disease must be investigated and adequately treated.A avaliação da Pressão Arterial (PA) nas consultas de vigilância dos Cuidados de Saúde Primários (CSP) resulta do reconhecimento da importância crescente da Hipertensão arterial (HTA) na idade pediátrica. Define-se HTA quando a PA sistólica e/ou diastólica encontram-se acima do percentil (P) 95. A HTA secundária é mais frequente na criança pré-adolescente e a principal etiologia são causas renais. Por haver uma causa tratável de HTA, é importante o diagnóstico atempado e a precocidade do tratamento. Apresenta-se o caso de uma pré-adolescente de 12 anos, assintomática, que, na consulta de vigilância, apresentou valores tensionais de 120/70 mm Hg (PA sistólica e diastólica > 5 mm Hg do P99). Dos antecedentes pessoais, realçar episódios de infeções do trato urinário febris nos primeiros 3 anos de vida; dos antecedentes familiares: obesidade, HTA e litíase renal. Exame físico: destaca-se o valor elevado de PA, que se manteve posteriormente em ambulatório. A ecografia renal revelou assimetria, com rim direito (RD) de dimensões globosas e rim esquerdo (RE) de menores dimensões, contornos irregulares e irregularidades da estrutura cortical (sequelas de processos inflamatórios). Referenciou-se à consulta de Nefrologia Pediátrica, onde complementou a investigação. O cintigrama renal mostrou RE de dimensões reduzidas e com marcada hipofunção (12,63%), RD de dimensões aumentadas (87,37%) e lesões cicatriciais bilaterais; a cistouretrografia miccional seriada revelou refluxo vesicouretral grau IV bilateral, que foi corrigido por via endoscópica. Iniciou terapêutica com ramipril, com dificuldade no controlo tensional confirmado com MAPA. Atualmente, mantém seguimento pela Nefrologia Pediátrica, medicada com ramipril 5 mg 2 vezes ao dia, colecalciferol e ferro oral. Por resistência ao tratamento, pondera-se nefrectomia. A doença renal parenquimatosa é causa frequente de HTA na criança, cujo prognóstico depende da precocidade do tratamento. O caso descrito alerta para a importância da avaliação sistemática da PA na consulta de saúde infantil, sempre que identificada, deve ser devidamente investigada e tratada.Revista Portuguesa de Hipertensão e Risco Cardiovascular2023-02-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.58043/rphrc.52https://doi.org/10.58043/rphrc.52Revista Portuguesa de Hipertensão e Risco Cardiovascular; N.º 93 (2023): Janeiro/Fevereiro; 38-421646-8287reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revistahipertensao.pt/index.php/rh/article/view/52https://revistahipertensao.pt/index.php/rh/article/view/52/59Direitos de Autor (c) 2023 Daniela Rocha, Maria João Faria, Rita Regadasinfo:eu-repo/semantics/openAccessRocha, DanielaFaria, Maria JoãoRegadas, Rita2024-02-03T07:36:45Zoai:ojs.revistahipertensao.pt:article/52Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:46:08.642936Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
PEDIATRIC HYPERTENSION - THE ROLE OF THE GENERAL PRACTITIONER IN HIGHLIGHTING A SILENT DISEASE HTA EM IDADE PEDIÁTRICA – O PAPEL DO MÉDICO DE FAMÍLIA AO DAR VOZ A UMA DOENÇA SILENCIOSA |
title |
PEDIATRIC HYPERTENSION - THE ROLE OF THE GENERAL PRACTITIONER IN HIGHLIGHTING A SILENT DISEASE |
spellingShingle |
PEDIATRIC HYPERTENSION - THE ROLE OF THE GENERAL PRACTITIONER IN HIGHLIGHTING A SILENT DISEASE Rocha, Daniela Hipertensão arterial Hipertensão secundária Pediatria Doença Renal Parenquimatosa arterial hypertension secondary hypertension pediatrics parenchymal kidney disease |
title_short |
PEDIATRIC HYPERTENSION - THE ROLE OF THE GENERAL PRACTITIONER IN HIGHLIGHTING A SILENT DISEASE |
title_full |
PEDIATRIC HYPERTENSION - THE ROLE OF THE GENERAL PRACTITIONER IN HIGHLIGHTING A SILENT DISEASE |
title_fullStr |
PEDIATRIC HYPERTENSION - THE ROLE OF THE GENERAL PRACTITIONER IN HIGHLIGHTING A SILENT DISEASE |
title_full_unstemmed |
PEDIATRIC HYPERTENSION - THE ROLE OF THE GENERAL PRACTITIONER IN HIGHLIGHTING A SILENT DISEASE |
title_sort |
PEDIATRIC HYPERTENSION - THE ROLE OF THE GENERAL PRACTITIONER IN HIGHLIGHTING A SILENT DISEASE |
author |
Rocha, Daniela |
author_facet |
Rocha, Daniela Faria, Maria João Regadas, Rita |
author_role |
author |
author2 |
Faria, Maria João Regadas, Rita |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Rocha, Daniela Faria, Maria João Regadas, Rita |
dc.subject.por.fl_str_mv |
Hipertensão arterial Hipertensão secundária Pediatria Doença Renal Parenquimatosa arterial hypertension secondary hypertension pediatrics parenchymal kidney disease |
topic |
Hipertensão arterial Hipertensão secundária Pediatria Doença Renal Parenquimatosa arterial hypertension secondary hypertension pediatrics parenchymal kidney disease |
description |
Blood Pressure (BP) assessment within Primary Health Care (CSP) surveillance consultations results from the recognition of a growing importance of Hypertension (HTN) problematic at a young age. Hypertension is defined by systolic and / or diastolic BP above the 95th percentile (P). Secondary hypertension is more frequent in pre-adolescent children and the main etiology are renal causes. Due to treatable cause of hypertension, early diagnosis and treatment are essential. We present a case of an asymptomatic pre-adolescent (12 years old), who, in the CSP surveillance consultation presented blood pressure values of 120/70 mm Hg (systolic and diastolic TA> 5 mm Hg from P99). The personal background showed episodes of feverish urinary tract infections during the first 3 years of life; from family background, obesity, hypertension and kidney stones are highlighted . Physical examination, besides high value of BP, which was maintained in outpatient control the following days. Renal ultrasound revealed asymmetry, with globose dimensions on right kidney (RD) and smaller dimensions on left kidney (ER), irregular contours and cortical structure irregularities (sequelae of inflammatory processes ). She was referred to Pediatric Nephrology consultation, where complemented the investigation of secondary causes of HTN. The renal scintigram showed ER of reduced dimensions and with marked hypofunction (12.63%), increased dimensions on RD (87.37%) and bilateral cicatricial lesions; serial voiding cystouretrography revealed bilateral grade IV vesicourethral reflux, which was corrected. Started antihypertensive therapy with ramipril, with difficulty in tension control confirmed by ABPM. Currently being followed at Pediatric Nephrology consultation, medicated with ramipril 5 + 5 mg, cholecalciferol and oral iron. Due to treatment resistance, nephrectomy is considered. Parenchymal kidney disease is a frequent cause of child hypertension, whose prognosis depends on early treatment. This show the importance of systematic BP assessment in child health consultations. When identified, the disease must be investigated and adequately treated. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-02-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.58043/rphrc.52 https://doi.org/10.58043/rphrc.52 |
url |
https://doi.org/10.58043/rphrc.52 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://revistahipertensao.pt/index.php/rh/article/view/52 https://revistahipertensao.pt/index.php/rh/article/view/52/59 |
dc.rights.driver.fl_str_mv |
Direitos de Autor (c) 2023 Daniela Rocha, Maria João Faria, Rita Regadas info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Direitos de Autor (c) 2023 Daniela Rocha, Maria João Faria, Rita Regadas |
eu_rights_str_mv |
openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Revista Portuguesa de Hipertensão e Risco Cardiovascular |
publisher.none.fl_str_mv |
Revista Portuguesa de Hipertensão e Risco Cardiovascular |
dc.source.none.fl_str_mv |
Revista Portuguesa de Hipertensão e Risco Cardiovascular; N.º 93 (2023): Janeiro/Fevereiro; 38-42 1646-8287 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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