Ambulatory monitoring of arterial pressure in a group of children with reflux nephropathy of different degrees

• Published in: Anales españoles de pediatría Vol. 49; no. 5; pp. 461 - 466
• Main Authors: Jiménez-Hereza, J M, Heras-Gironella, M, Loris-Pablo, C, Garagorri-Otero, J, Tardós-Solano, M J
• Format: Journal Article
• Language: Spanish
• Published: Spain 01-11-1998
• Subjects: Blood Pressure Monitoring, Ambulatory; Child; Child, Preschool; Female; Humans; Hypertension, Renal - diagnosis; Kidney Diseases - physiopathology; Male; Severity of Illness Index; Vesico-Ureteral Reflux - complications
• ISSN: 0302-4342

The purpose of this study was to search for risk factors for the evolution reflux nephropathy by comparing the results of the ambulatory blood pressures in a group of children with reflux nephropathy of different degrees.
Out-patient blood pressure monitoring was performed in 31 children (15 males and 15 females) affected to different degrees by reflux nephropathy. This was done during a 24-hour period on a normal schoolday by using a Spacelabs 90207 oscilometric monitor. An appropriately sized armband was chosen for each case with the readings being programmed for every 20 minutes between 8:00 a.m. and 23:00 p.m. and every 30 minutes for the remaining readings. The mean blood pressure, blood pressure load and hyperbaric index over the 24 hour period (on all the readings obtained), activity period (0800 to 2200 hours) and the resting period (midnight to 6:00 a.m.) were calculated. The circadian variability (difference and ratio between the mean values of active and resting periods and the nocturnal fall in blood pressure as a percentage of the daytime mean value) was also determined. The children were classified into subgroups according to their degree of reflux nephropathy: Group 1) Degrees A and B of unilateral reflux nephropathy. Group 2) Degrees C and D of unilateral reflux nephropathy and Group 3) Bilateral nephropathy. Those monitorings with a percentage of erroneous readings over 30% were excluded.
Two children were excluded because of a high percentage of erroneous readings. We could not find any significant difference among the three groups in casual blood pressure. We observed significant differences between the group formed by children with unilateral reflux nephropathy and children with bilateral reflux nephropathy in the blood pressure during the resting period. No significant differences were found among the three groups in the tensional load, hyperbaric index or the variables that determine the nightly descent in blood pressure.
Ambulatory blood pressure monitoring allow the detection of risk factors for the evolution of reflux nephropathy; i.e., higher risk of blood pressure elevation, especially during the resting period and mainly for bilateral reflux nephropathy.