NEONATAL RENOVASCULAR HYPERTENSION AND TARGET-ORGAN DAMAGE

Abstract

Introduction: Arterial hypertension in the neonatal period is defined by blood pressure values above the 95th percentile, taking into account post-menstrual age. At this age group, it is usually due to renal disease (parenchymal or renovascular diseases). The target-organ lesion may be present at these ages; however, it can be potentially reversible, if the diagnosis and the therapeutic intervention are made in a timely manner and orientated to the cause.

Case description: Female term newborn, second child of young and non-blood related parents, diabetic mother (type II diabetes mellitus); in which feeding difficulties, hyporreactivity and high blood pressure values were detected by the 3rd day of life. The cardiac evaluation, with an echocardiogram, revealed an important impairment of biventricular function, dilation of the right cavities and left ventricular hypertrophy. The initial renal function analytic assessment was normal and the renal Doppler ultrasound pointed out a left renal artery’s stenosis. The abdominal computed tomography angiography confirmed stenosis and obliteration of the left renal artery, with reduced vascular patency and lack of homolateral kidney perfusion. A catheterization was performed to clarify the aetiology and as an attempt to solve the clinical situation. It brought up the hypothesis of obstruction by a thrombus, whereby she started therapy with low molecular weight heparin. The hypotensive treatment, initially intravenously, was on the 17th day of life replaced to oral treatment, with gradual improvement and control of blood pressure values. She was discharged at the 30th day of life, with multidisciplinary follow-up and with blood pressure values controlled. The cardiac reassessment, at the time of discharge, revealed a regression of the changes initially described. Nephrological progression revealed loss of function of the left kidney, compatible with the presence of functionally significant stenosis of the left renal artery. She underwent left nephrectomy at nine months of life. The anatomopathological evaluation was compatible with the clinical diagnosis of left renal artery stenosis, likely because of artery’s hypoplasia. She keeps being followed up and currently, she is no longer under hypotensive treatment.

Discussion: The neonatal hypertension is a rare condition, usually associated to a secondary cause, which most of times are treatable. A target-organ lesion can arise in early ages as the neonatal period. An early and adequate approach allows the reversal of the findings, with a good prognosis.