Hypertensive crisis as the first manifestation of renaldisease in children and adolescents: a report of three cases and review of the literature

Introduction: Hypertensive crisis is a life-threatening condition, defined as severe hypertension complicated with acute target-organ dysfunction (mainly neurological, renal or cardiac). It rarely occurs in childhood and most children and adolescents who presents with hypertensive crisis symptoms have secondary hypertension, mainly of renal etiology. Case reports:We present the cases of three children with severe hypertension of different renal etiology who presented with the characteristic features of hypertensive emergency. Case 1 is a 11-year-old girl with reflux nephropathy who at admission had blood pressure (BP) as high as 250/200 mmHg. She was lethargic, with headache, vomiting and a 3-month history of weight loss. Case 2 is a 13-year-old boy with renal artery stenosis who had clinical presentation of generalized tonic-clonic seizures and BP 220/150 mmHg. Case 3 is a 9-year-old boy with chronic renal insufficiency of unexplained etiology and BP as high as 220/135 mmHg. This patient, like two others, presented dominantly with symptoms of hypertensive encephalopathy, aswell as signs of renal damage. All three patients have documented hypertrophic cardiomyopathy. In the patient who had renal artery stenosis, the removal of his dysplastic atrophic right kidney failed to normalize his blood pressure. Conclusion: We discuss the cases of unrecognized long-standing hypertension, with progression to malignant hypertension, as the first manifestation of renal disease – two with renal parenchymal disorders and one with renovascular disease. Hypertension is underdiagnosed in children and the purpose of these case reports is to raise awareness about it and point to the importance of routine careful measurement of blood pressure in pediatric patients

Hypertensive crisis as the first manifestation of renaldisease in children and adolescents: a report of three cases and review of the literature

Introduction: Hypertensive crisis is a life-threatening condition, defined as severe hypertension complicated with acute target-organ dysfunction (mainly neurological, renal or cardiac). It rarely occurs in childhood and most children and adolescents who presents with hypertensive crisis symptoms have secondary hypertension, mainly of renal etiology. Case reports:We present the cases of three children with severe hypertension of different renal etiology who presented with the characteristic features of hypertensive emergency. Case 1 is a 11-year-old girl with reflux nephropathy who at admission had blood pressure (BP) as high as 250/200 mmHg. She was lethargic, with headache, vomiting and a 3-month history of weight loss. Case 2 is a 13-year-old boy with renal artery stenosis who had clinical presentation of generalized tonic-clonic seizures and BP 220/150 mmHg. Case 3 is a 9-year-old boy with chronic renal insufficiency of unexplained etiology and BP as high as 220/135 mmHg. This patient, like two others, presented dominantly with symptoms of hypertensive encephalopathy, aswell as signs of renal damage. All three patients have documented hypertrophic cardiomyopathy. In the patient who had renal artery stenosis, the removal of his dysplastic atrophic right kidney failed to normalize his blood pressure. Conclusion: We discuss the cases of unrecognized long-standing hypertension, with progression to malignant hypertension, as the first manifestation of renal disease – two with renal parenchymal disorders and one with renovascular disease. Hypertension is underdiagnosed in children and the purpose of these case reports is to raise awareness about it and point to the importance of routine careful measurement of blood pressure in pediatric patients

Experiences with the day care hospital at the Department of pediatrics, University hospital Sestre milosrdnice (Sisters of mercy)

Prva iskustva s dnevnom bolnicom na našoj Klinici počeli smo stjecati u siječnju 2002. godine. Tada je našu Kliniku, najstariji pedijatrijski odjel u Hrvatskoj, na njezin 98. rođendan opustošio katastrofalan požar. Dvadeset i četiri sata nakon toga počeli smo opservirati i liječiti naše pacijente u improviziranim bolničkim prostorima na Klinici za internu medicinu. Tamo nismo mogli smjestiti svih 98 postelja, jer je dobiveni prostor odgovarao jednoj petini prijašnjeg prostora. Tamo smo smjestili samo 30 stacionarnih ležajeva, dok smo ostale pacijente zbrinuli kroz dnevnu bolnicu. Nesvakidašnja situacija zahtijevala je ulaganje maksimalnog napora te brzu dijagnostičku obradu i učinkovito liječenje što većeg broja bolesnika. Nakon stjecanja nužnog iskustva liječnici, medicinske sestre, kao i pacijenti i njihovi roditelji, bili su zadovoljni takvim načinom liječenja, usprkos potpuno neprikladnim smještajnim uvjetima, koji su bili glavni problem u funkcioniranju Klinike do ponovnog preseljenja u nove, obnovljene prostore. Nakon četverogodišnjeg iskustva s dnevnom bolnicom iznijeli bismo naša prvenstveno pozitivna iskustva, ali i neke probleme s kojima smo se sretali.We began to acquire our first experiences of a day care hospital at our Clinic in January 2002. That was the time when our Clinic, the oldest pediatric department in Croatia, was destroyed by fire on its 98th anniversary. 24 hours after the fire we restarted observation of a number of our patients in an improvised, donated ward of our University hospital, at the Department of internal medicine. We could not accommodate 98 beds on the ward that was only one fifth of the size of our old ward. We equipped only 30 beds for in-patients, while the others were examined and treated in the day-care hospital. This unusual situation required a great deal of effort, quick examinations and efficacious treatment of as large as possible number of patients in the couple of hours a day. After acquiring the necessary experience both doctors, nurses and patients and their parents became content with that kind of treatment despite the absolutely inadequate accommodation which was the main obstacle until we moved into our present, modern renewed facilities. After the four years of experience with the day care hospital we shall say something first about all our positive experiences although we shall mention some problems that occurred