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Reduction of arterial pressure following relief of obstruction in patients with hydronephrosis
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi. (Paediatric surgery)ORCID-id: 0000-0001-9578-1783
(engelsk)Manuskript (preprint) (Annet vitenskapelig)
Emneord [en]
blood pressure, hydronephrosis, hypertension, kidney, renal function, ureteral obstruction
HSV kategori
Identifikatorer
URN: urn:nbn:se:uu:diva-338672OAI: oai:DiVA.org:uu-338672DiVA, id: diva2:1173086
Tilgjengelig fra: 2018-01-11 Laget: 2018-01-11 Sist oppdatert: 2019-11-11
Inngår i avhandling
1. High Blood Pressure in Children with Hydronephrosis
Åpne denne publikasjonen i ny fane eller vindu >>High Blood Pressure in Children with Hydronephrosis
2018 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The most common cause of secondary hypertension is intrinsic renal disease, but little is known about the influence of hydronephrosis on blood pressure. In this thesis, the risk of development of hypertension in children with hydronephrosis was studied.

Experimental and clinical studies were combined in order to investigate the risk of developing elevated blood pressure following conservative treatment of hydronephrosis, and to further explore underlying mechanisms. We started with a clinical study in children (study I), which in agreement with previous experimental studies, showed that blood pressure was lowered by surgical management of hydronephrosis. In parallel, an experimental study was conducted (study II) to investigate the involvement of renal sympathetic nerve activity in development of hypertension following induction of hydronephrosis caused by pelvo-ureteric junction obstruction. Renal denervation of the obstructed kidney attenuated hypertension and restored the renal excretion pattern, effects that were associated with reduced activity of both renal NADPH oxidase derived oxidative stress and components of the renin-angiotensin-aldosterone system.

Based on the findings in studies I and II, we continued our studies in children with hydronephrosis, and including two control groups as comparisons with the hydronephrotic group (study III). In the same study, we further investigated potential mechanism(s) of hypertension by analyzing markers of oxidative stress and nitric oxide homeostasis in both urine and blood samples. We demonstrated increased arterial pressure and oxidative stress in children with hydronephrosis compared with healthy controls, which was restored to normal levels by surgical correction of the obstruction. Finally, in a retrospective cohort study, blood pressure of adult patients undergoing surgical management of hydronephrosis due to pelvo-ureteric junction obstruction was assessed (study IV). Similar to that demonstrated in the pediatric hydronephrotic population, blood pressure was significantly reduced by relief of the obstruction. In addition, blood pressure was increased again if the hydronephrosis recurred, and was reduced again following re-operation.

It is concluded that conservative management of hydronephrosis in children is associated with a risk for development of high blood pressure, which can be reduced or even normalized by relief of the obstruction. The mechanism(s), at least in part, is coupled to increased oxidative stress.

sted, utgiver, år, opplag, sider
Uppsala: Acta Universitatis Upsaliensis, 2018. s. 71
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1417
Emneord
Blood pressure, hydronephrosis, hypertension, ambulatory blood pressure monitoring, nitric oxide, oxidative stress, pelvo-ureteric junction obstruction.
HSV kategori
Forskningsprogram
Barnkirurgi
Identifikatorer
urn:nbn:se:uu:diva-338678 (URN)978-91-513-0206-5 (ISBN)
Disputas
2018-03-01, Rosénsalen, Akademiska barnsjukhuset ingång 95-96, Uppsala, 13:15 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2018-02-07 Laget: 2018-01-11 Sist oppdatert: 2019-11-11

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