Comparison of childhood hypertension guidelines

Hipertansiyon (HT) çocukluk çağlarında giderek artan sıklıkta görülmektedir. Bu hastaların daha iyi değerlendirilmesi için çeşitli kılavuzlar yayınlanmıştır. Bunlar içinde en sık kullanılanlar; ABD Ulusal Kalp, Akciğer ve Kan Enstitüsü (NHLBI)’nün Ulusal Yüksek Kan Basıncı Eğitim Programı (NHBPEP) tarafından güncellenerek hazırlanan ve 2004’te yayınlanan 4. Rapor (4. Rapor-2004), 2016 yılında Avrupa Hipertansiyon Derneği tarafından hazırlanan kılavuz (ESH-2016), ve en sonuncusu 2017’de Amerikan Pediatri Akademisi tarafından hazırlanan kılavuzdur (AAP-2017). Bu kılavuzlar benzer olsa da aralarında ciddi farklar bulunmaktadır. 4. Rapor-2004 ve ESH-2016 kılavuzları, daha önce Amerikalı çocuklarda saptanan, yaşa ve boya göre oluşturulan kan basıncı (KB) persentil tablolarını kullanır. Daha sonra obez çocukların ölçümleri çıkarılarak yeni tablolar oluşturulmuş ve AAP-2017’de bu tablolar kullanılmıştır. ESH-2016’da 16 yaş, AAP-2017’de ise 13 yaşından itibaren KB değerlendirmelerinin erişkin kılavuzlarına göre yapılması önerilir. Hipertansif hastanın değerlendirilmesi, Yaşam İçi Kan Basıncı İzlemi (YİKBİ) kriterleri, laboratuvar testlerinin zamanlaması ve tedavi kılavuzlara göre farklılık göstermektedir. Sonuç olarak; henüz tüm dünya çocuklarını kapsayan evrensel KB tabloları oluşturulamamış olduğundan, ofis KB ve YİKBİ’nin değerlendirilmesinde hangi kılavuza göre hareket edileceği noktasında yaş, etnik ve coğrafi koşulların göz önünde bulundurulması gerekmektedir. Güncel olarak yayınlanan kılavuzların takip edilmesi ile ileride gelişebilecek kardiyovasküler olayların azaltılması mümkün olabilecektir.Hypertension (HT) is seen with increasing frequency in childhood. Various guidelines have been published to better evaluate these patients. The most frequently used of these are; The 4th Report (The 4th Report-2004) updated and published by the National Heart Lung and Blood Institute (NHLBI) National High Blood Pressure Education Program (NHBPEP) Working Group in 2004, a guideline prepared by the European Society of Hypertension in 2016 (ESH-2016), the last one is the guideline prepared by the American Academy of Pediatrics in 2017 (AAP-2017). Although these guidelines have some similarities, there are serious differences between them. The 4 th Report-2004 and ESH-2016 guidelines use blood pressure (BP) percentile tables based on age and height previously determined in American children. Then, new tables were created by extracting the measurements of obese children and these tables were used in AAP-2017. From the age of 16 in ESH-2016 and 13 in AAP-2017, it is recommended that BP evaluations should be made according to adult guidelines. Evaluation of the hypertensive patient, Ambulatory Blood Pressure Monitoring (ABPM) criteria, the timing of laboratory tests and treatment differ according to guidelines. As a result; since universal BP tables covering all children around the world have not yet been created; age, ethnic and geographical conditions should be taken into account when evaluating which guidelines the office BP and ABPM should follow. By following the currently published guidelines, it will be possible to reduce future cardiovascular events

Kidney involvement in tuberous sclerosis complex

Objective: Tuberous sclerosis complex (TSC) is a multisystem autosomal dominant disease characterized by the development of benign neoplasia in skin, brain and kidneys. There are three particular renal disorders in TSC including renal cysts, renal angiomyolipoma and renal cell carcinoma. In the current study we aimed to investigate renal findings of TSC patients followed in our clinic. Methods: Patients’ family history, convulsion history, age, gender, physical examination findings, renal function tests, ultrasound and/or magnetic resonance imaging, results of computerized tomography, echocardiography and eye findings were found from hospital records and evaluated. Tuberous sclerosis diagnosis was made by clinical and imaging findings in 19 patients. Results: Nineteen cases were included in study. Eleven was males and the remaining 8 were females. The mean age was 75.5±65, 1 month (3 month- 18 year) and follow up time was 14.6±7 month. Renal angiomyolipoma was the most commonly seen pathology alone (4 patients-21%) and with renal cysts (5 patients-26.3%). Autosomal dominant polycystic kidney disease was with TSC in two patients. Four patients were presented with only simple renal cysts. Two patients had increased renal echogenicity and one patient had mild pelvicaliectasis. Ureteropelvic junction obstruction, urinary tract infection, nephrolithiasis and hemorrhages are commonly seen complications in TSC. Five patients had history of urinary tract infection. None of the patients had bleeding or rupture complication. Hypertension and end stage renal disease were not seen. Conclusion: The most commonly seen renal lesions in TSC are angiomyolipomas and kidney cysts. At the time of TSC diagnosis, all the children must be screened for renal involvement and we should remember renal findings can change with time and new findings can be added to old ones. Therefore nephrologist follow up has been done in all patients