RENAL AUTOTRANSPLANT AS AN EFFECTIVE TREATMENT IN REFRACTORY RENOVASCULAR HYPERTENSION. REPORT OF A CASE.
Abstract
Background
Systemic hypertension (HTA) in children is rare and usually of secondary origin. Among the main causes are renovasculares. Renal artery stenosis (RAS) is the most common cause. Bilateral renal autotransplantation has been reported in isolated cases as an alternative to definitive treatment to preserve the organ, with a low rate of morbidity and mortality and satisfactory results.
Objectives
Description of a clinical case of a patient who underwent bilateral renal autotransplantation (RAT) for refractoriness to multiple pharmacological treatment with acute renal failure. Indications, management, complications and prognosis are reviewed.
Methods
Female of 10 years old, with migraine of one year of onset and treatment; suddenly she presented left hemiplegia, headache and vomiting in projectile, diagnosing a hemorrhagic cerebral vascular accident (CVA), hypertrophy of the left ventricle, HTA and renal failure. She required treatment with multiple antihypertensive drugs, without control and refractory to medical treatment. RAT was performed bilaterally in two stages. She had perinephric hematoma and thrombosis of the right renal graft, with ipsilateral nephrectomy.
Results
Currently in follow-up reversibility of hemiparesis, adequate renal vascular flow and clearance, good quality of life, minimal pharmacological therapy, excluding renal substitution therapies or allogeneic transplantation.
Conclusion
Severe HTA in pediatrics can present emergencies that potentially compromise life and function. RAT is a highly effective procedure to treat complex renovascular lesions. Due to the complexity of our patient, bilateral RAT was required, with intensive pediatric management, which commits the physician to know the treatment, evolution, complications and prognosis of the entity, in order to offer adequate care with quality.