膀胱尿管逆流現象にみられた小児腎性高血圧

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A case of hypertension in a child with vesiccureteral reflux is reported. The patient was a 9-year-old girl who complained of left facial palsy. The blood pressure was markedly elevated and peripheral plasma renin activity was also elevated. Medical history was unremarkable. Urinalysis was normal except for slight proteinuria. Radiological examinations revealed a right small kidney with poor function; stenosis of renal artery was not demonstrated. Blood samples of bilateral renal veins for renin activity were drawn, and the ratio was determined to be 5.0. Preoperative diagnosis was hypertension with elevated renal vein renin due to right renal hypoplasia, and right nephrectomy was done. The size of the kidney was 4.3×2.5×1.0 cm and it weighed 15g. Pathological findings of the specimen were compatible with those of chronic pyelonephritis. Postoperative voiding cystogram showed reflux into the residual ureter. Postcperative course was uneventful. Blood pressure and the level of peripheral plasma renin activity were ncrmalized by the 7th and 3rd postoperative day, respectively. This case was unique in that facial palsy was the initial symptom, in that it was sterile reflux nephropathy with renin-dependent hypertemion in unilateral reflux nephropathy, and in that blood pressure was promptly normalized after nephrectomy.
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