[Modes of intensive therapy for arterial hypertension in children with terminal chronic kidney failure].
In spite of considerable progress in development of pediatric science, intensive therapy of kidney diseases remains the pressing issue because of high lethality among patients with renal failure (RF). Cardiovascular diseases, especially malignant hypertension syndrome with development of left ventricular insufficiency, are leading among the causes of late deaths of postdialysis patients. We studied hemodynamics in 18 children with terminal chronic renal failure running with marked arterial hypertension and left ventricular hypertrophy. We have found that high blood pressure was initially caused by hyperhydration and hypernatriemia. After hemodialysis, children with KT/V > 1 developed hypertension due to hyperkinetic hemodynamics. Establishment of "dry weight" of the child on programmed dialysis was followed by renin-dependent arterial hypertension which was treated by inhibitors of angiotensin-converting enzyme and calcium antagonists, in one case by nephrectomy. In hemodialysis regimen KT/V < 1, dry weight was not achieved and hyperhydration-caused hypertension remained. Moderate arterial hypertension due to cukinetic hemodynamics was achieved only after 4 weeks of hemodialysis in administration of calcium antagonists, beta-blockers and central sympatholytics.
A M
AM
Sharipov
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002648:Child; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology; D008297:Male
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers