title: Aggressive blood pressure control for chronic kidney disease unmasks moyamoya!
abstract: Hypertensive crises in children or adolescents are rare, but chronic kidney disease (CKD) is a major risk factor for occurrence. Vesicoureteral reflux nephropathy is a common cause of pediatric renal failure and is associated with hypertension. Aggressive blood pressure (BP) control has been shown to delay progression of CKD and treatment is targeted for the 50th percentile for height when compared with a target below the 90th percentile for the general pediatric hypertensive patient. We present a case of an adolescent presenting with seizures and renal failure due to a hypertensive crisis. Hypertension was thought to be secondary to CKD as she had scarred echogenic kidneys due to known reflux nephropathy. However, aggressive BP treatment improved kidney function which is inconsistent with CKD from reflux nephropathy. Secondly, aggressive BP control caused transient neurological symptoms. Further imaging identified moyamoya disease. We present this case to highlight the consideration of moyamoya as a diagnosis in the setting of renal failure and hypertensive crisis.
authors.affiliation: Department of Pediatrics (Division of Nephrology) , Washington University School of Medicine , St. Louis, MO , USA.
authors.forename: T Keefe
authors.initials: TK
authors.lastname: Davis
authors.affiliation: Department of Pediatrics (Division of Nephrology) , Washington University School of Medicine , St. Louis, MO , USA.
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Halabi
authors.affiliation: Department of Internal Medicine and Pediatrics , Greenville Regional Hospital , Greenville, IL , USA.
authors.forename: Philp
authors.initials: P
authors.lastname: Siefken
authors.affiliation: Department of Neurology (Division of Developmental and Pediatric Neurology) , Washington University School of Medicine , St. Louis, MO , USA.
authors.forename: Swati
authors.initials: S
authors.lastname: Karmarkar
authors.affiliation: Department of Neurological Surgery (Division of Pediatric Neurosurgery) , Washington University School of Medicine , St. Louis, MO , USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Leonard
keywords: acute renal failure; hypertension; hypertensive emergency; moyamoya; reflux nephropathy; vesicoureteral reflux