Scars mark hypertension risk in vesicoureteral reflux

By Sally Robertson, B.Sc.Nov 21 2012

Renal scarring (RS) associated with vesicoureteral reflux (VUR) is a significant risk factor for developing hypertension, shows a study of pediatric patients.

Children with VUR, the abnormal movement of urine from the bladder into the ureters or kidneys, must be carefully monitored for the development of RS and hypertension, warn Kibriya Fidan (Gazi University Medical Hospital, Ankara, Turkey) and colleagues.

"As hypertension accelerates renal injury, its early identification and management would help to reduce mortality and morbidity," explain Fidan et al.

The team also reports in Urology that ambulatory blood pressure monitoring (ABPM) seems to be superior to office measurements of blood pressure (BP) for identifying patients with hypertension.

In a study of 240 patients (mean age 7.1 years) with VUR who attended a baseline examination, manual BP measurements identified hypertension in 13 (5.4%) individuals. The ABPM measurements obtained at the same time were also compatible with this diagnosis.

The team reports that all 13 individuals with baseline hypertension had RS, while none of the patients without RS at baseline had hypertension.

During follow up, ABPM identified newly developed hypertension in 17 additional patients, all of whom had RS at baseline, meaning the rate of hypertension had increased to 12.5% by study end. However, when office measurements of BP were used, hypertension was only identified in six additional patients compared with baseline.

Increases in rates of RS and hypertension correlated positively with increases in the degree of VUR, which was graded according to the criteria of International Reflux Study Group.

In addition, the mean systolic and diastolic ABPM measurements were significantly higher in patients with high-grade RS (as assessed by a renal parenchymal examination) than in those with low-grade RS, at 139.2/87.1 mmHg versus 130.4/79.8 mmHg.

"Hypertension is a serious complication in children with reflux nephropathy and is associated with the severity of RS and VUR grade," say Fidan et al.

"Because ABPM seems to be superior vs clinical measurements of BP, its use may be considered in this patient group in addition to manual BP measurements to improve the accuracy of diagnosis," they conclude.

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