CLINICAL CASE OF ARTERIAL HYPERTENSION IN A NEWBORN

Abstract

Aim. To use personal clinical experience in monitoring and treating a newborn with persistent arterial hypertension (AH) due to left renal artery stenosis to demonstrate the current state of this problem in the context of limited experience of work with such rare pathologies in children.Materials and methods. The research was based on the examination and treatment of a newborn with persistent AH due to left renal artery stenosis. The complex of diagnostic procedures included: clinical and laboratory examinations, X-ray examination methods (with the use of contrast agents), magnetic resonance imaging, ultrasound examination and Dopplerography, and histological examination of surgical material.Results. Conservative treatment of the patient's AH with the use of antihypertensive agents did not achieve desired results.Taking into account possible etiologic and pathogenetic factors of AH in newborns, Doppler examination was performed to exclude congenital heart defects (coarctation of the aorta). Pathology was excluded.Cortisol and 17-OH progesterone levels were determined to exclude suprarenal pathology and showed the following: cortisol level was 173.9% higher than the maximum permissible level; 17-OH progesterone level was 9.9% higher than the norm.Considering the presence of neurological symptoms, an MRI of the brain with angiography was performed. No pathology was detected.Due to the presence of persistent arterial hypertension, which did not respond to medication, a CT with contrast was ordered, during which were revealed CT-signs of critically small diameter of the left renal artery (probable dissection) with pronounced cystic and ischemic changes of the lateral half of the left kidney without excretory function at 15 min. The main treatment measures included the following: adequate preoperative preparation, anesthetic support and the selection of an adequate and effective operative method to eliminate the pathology. The only available method of surgical intervention was nephrectomy - removal of the left kidney.Analyzing the results of the investigation, it can be stated that nephrectomy is the pathogenetic method of treatment of this pathology. Steady stabilization of arterial blood pressure was achieved within 1 hour after the operation.Conclusions. 1. When persistent AH is detected in a newborn, the presence of organic pathology should be excluded. 2. If the patient has organic pathology that causes a persistent increase in arterial blood pressure, the root cause of the pathology should be eliminated if possible. 3. Conservative treatment of persistent AH in children caused by renovascular or renal factors does not provide significant results and is not appropriate. 4. Nephrectomy is the pathogenetic method of treating AHT in a newborn with renal artery stenosis.