succimer and Hypertension

The role of imaging is to establish the cause of systemic hypertension, the main focus being the kidneys. All children require a Doppler ultrasound examination followed by a radioisotope study, usually 99mTc-DMSA. This combination will resolve most clinical situations. There is no role for the intravenous urogram in the majority of children. Arteriography and renal vein renin sampling are reserved for a small proportion of children. Imaging should always start with the least invasive procedure with the lowest radiation burden and high radiation techniques reserved for selected cases. The use of ACE inhibition may allow the diagnosis of renovascular disease in paediatrics noninvasively.

Topics: Angiography; Diagnostic Imaging; Humans; Hypertension; Organotechnetium Compounds; Pediatrics; Renal Veins; Renin; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography

Exstrophy-epispadias complex (EEC) is a complex malformation of the lower abdominal wall, bladder, and pelvic floor, which necessitates multiple successive reconstruction procedures. Surgical and infectious complications are frequent. Our aim was to evaluate kidney function in these patients.. This cross-sectional study included patients with EEC, followed since birth in a pediatric urology clinic, who underwent nephrological evaluation (blood pressure (BP) measurement and blood and urine chemistries) and imaging studies (urinary tract ultrasound and DMSA kidney scan) during 2017-2020.. The high rate of signs of kidney injury in pediatric patients with EEC dictates early-onset long-term kidney function monitoring by joint pediatric urological and nephrological teams. A higher resolution version of the Graphical abstract is available as Supplementary information.

Topics: Bladder Exstrophy; Child; Cross-Sectional Studies; Epispadias; Humans; Hypertension; Kidney; Male; Succimer

Ask-Upmark kidney (AUK) is a scarred segment of the kidney, characterized by formation of primitive tubular and glomerular structures, and sporadically diagnosed as a cause of hypertension (HTN). A 6-year-old girl with neurofibromatosis type 1 (NF1) and moyamoya syndrome had severe HTN. Based on past history, she had HTN at the age of 1.5 years. Laboratory examination revealed slightly elevated plasma and renal venous renin activity without lateralization. No evidence of pheochromocytoma, or coarctation of the aorta was found. Contrast-enhanced computed tomography (CT) showed an area of hypoperfusion in the upper and middle poles with reduced size of the right kidney. The results of dimercaptosuccinic acid scintigraphy were in accordance with those of contrast-enhanced CT. Selected renal arteriography revealed a paucity of peripheral vascularity in the same parts of the right kidney. In the absence of a history of urinary tract infection and vesicoureteral reflux by cystography, we presumed that the severe HTN may be due to segmental hypoplasia of the kidney, AUK, with a possible contribution from NF1. Although renal artery stenosis and pheochromocytoma are well-known causes of HTN in NF1, this case demonstrates that HTN can be caused by AUK in patients with NF1.

Topics: Angiography; Antihypertensive Agents; Child; Coloboma; Contrast Media; Female; Humans; Hypertension; Kidney; Kidney Glomerulus; Moyamoya Disease; Neurofibromatosis 1; Proteinuria; Radionuclide Imaging; Renal Insufficiency; Renin; Succimer; Tomography, X-Ray Computed; Treatment Outcome; Vesico-Ureteral Reflux

Improved management for spina bifida (SB) has increased the number of patients transitioning to adult care. This trend increases the importance of maintaining renal function concurrently with bladder function in patients with SB. Dimercaptosuccinic acid (DMSA) renal scanning is an optimal tool for investigating renal insufficiency in children with SB; however, the benefits of DMSA scans in adulthood are unclear. The role of DMSA renal scans for patients with SB during the transition to adulthood (15-25 years of age) to reveal their association with current renal function was investigated.. DMSA renal scanning was routinely performed patients with SB aged 15-25 years concurrently with examination of serum creatinine, serum cystatin C, urinalysis, and blood pressure between January 2006 and August 2016. Hypertension was defined as systolic or diastolic pressure above the age-specific normal range. The estimated glomerular filtration rate (eGFR) using serum creatinine or cystatin C was calculated; decreased eGFR was defined as eGFR below 90 mL/min/1.73 m. Eighty-seven patients (36 males and 51 females) were analyzed. Median age was 19 years (range 15-24 years); 28 patients (32%) had renal scarring. Patients with renal scarring had significantly higher rates of hypertension (n = 13, 46%) and decreased eGFR (n = 5, 18%). However, there was no difference in proteinuria between the groups (Table). The group with renal scarring had significantly lower eGFR.. This study showed that DMSA scans in patients with SB aged between 15 and 25 years were useful for assessing renal scarring despite a history of febrile urinary tract infection. DMSA scans could be performed in all patients with SB in the transition to adulthood to detect renal scarring. This study also showed that renal scarring was associated with hypertension and decreased eGFR in this age group. Treatment with antihypertensive drugs should be considered for patients with SB with renal scarring in this age range to protect renal function.. Spina bifida patients in the age of transition to adulthood with renal scarring already showed signs of chronic kidney disease, suggesting that DMSA renal scans could be useful to identify patients who require close monitoring of renal function.

Topics: Adolescent; Cicatrix; Cross-Sectional Studies; Glomerular Filtration Rate; Humans; Hypertension; Kidney Diseases; Spinal Dysraphism; Succimer; Transition to Adult Care; Young Adult

Topics: Adolescent; Chelating Agents; Diagnosis, Differential; Exanthema; Female; Humans; Hypertension; Mercury; Mercury Poisoning; Skin Lightening Preparations; Succimer; Tachycardia

To assess the impact of multiple access tracts during percutaneous nephrolithotomy (PCNL) on short- and midterm renal function, and to determine risk factors predicting renal function deterioration and/or recoverability.. Patients undergoing PCNL with multiple punctures were prospectively enrolled. Preoperative evaluation included dimercaptosuccinic acid and diethylenetriaminepentaacetic acid renography. Patients were classified according to baseline renal function into patients with normal (<1.4 mg/dL) serum creatinine (group A) and patients with elevated (≥1.4 mg/dL) serum creatinine (group B). Patients were followed with serial serum creatinine evaluations and a repeated renography at 12 months. Factors evaluated for possible impact on renal function changes included preoperative renal function, number of access tracts, hypertension, and diabetes mellitus.. There were 102 patients 21 to 65 (mean 39.9) years who completed the study. Fifty patients (group A) had normal preoperative serum creatinine levels and glomerular filtration rate (GFR), which showed no statistically significant change 12 months after PCNL. Fifty-two patients had baseline renal impairment (group B), and they experienced statistically significant worsening of the serum creatinine level and GFR at 12 months postoperatively (P<0.001). Ten (19.23%) patients in group B had a significant deterioration of GFR more than 25%. Independent risk factors for this poor outcome were elevated (≥1.4 mg/dL) preoperative serum creatinine level, diabetes, and hypertension.. PCNL with multiple tracts carries a risk of adversely affecting renal function. Preoperative baseline renal impairment, diabetes, and hypertension are risk factors for significant renal function deterioration after the procedure.

Topics: Adult; Aged; Biomarkers; Creatinine; Diabetes Complications; Female; Glomerular Filtration Rate; Humans; Hypertension; Kidney Calculi; Male; Middle Aged; Nephrostomy, Percutaneous; Radioisotope Renography; Renal Insufficiency; Risk Factors; Succimer

Combination therapy can play a significant role in the amelioration of several toxic effects of lead (Pb) and recovery from associated cardiovascular changes.. To investigate the effects of combination therapy on the cardiovascular effects of perinatal lead exposure in young and adult rats Methods: Female Wistar rats received drinking water with or without 500 ppm of Pb during pregnancy and lactation. Twenty-two- and 70-day-old rat offspring who were or were not exposed to Pb in the perinatal period received meso-dimercaptosuccinic acid (DMSA), L-arginine, or enalapril and a combination of these compounds for 30 additional days. Noradrenaline response curves were plotted for intact and denuded aortas from 23-, 52-, 70-, and 100-day-old rats stratified by perinatal Pb exposure (exposed/unexposed) and treatment received (treated/untreated).. Systolic blood pressure was evaluated and shown to be higher in the 23-, 52-, 70-, and 100-day age groups with Pb exposure than in the corresponding control age groups: 117.8 ± 3.9*, 135.2 ± 1.3*, 139.6 ± 1.6*, and 131.7 ± 2.8*, respectively and 107.1 ± 1.8, 118.8 ± 2.1, 126.1 ± 1.1, and 120.5 ± 2.2, respectively (p < 0.05). Increased reactivity to noradrenaline was observed in intact, but not denuded, aortas from 52-, 70-, and 100-day-old exposed rats, and the maximum responses (g of tension) in the respective Pb-exposed and control age groups were as follows: 3.43 ± 0.16*, 4.32 ± 0.18*, and 4.21 ± 0.23*, respectively and 2.38 ± 0.33, 3.37 ± 0.13, and 3.22 ± 0.21, respectively (p < 0.05).. All treatments reversed the changes in vascular reactivity to noradrenaline in rats perinatally exposed to Pb. The combination therapy resulted in an earlier restoration of blood pressure in Pb-exposed rats compared with the monotherapies, except for enalapril therapy in young rats. These findings represent a new approach to the development of therapeutic protocols for the treatment of Pb-induced hypertension.

Topics: Age Factors; Animals; Antihypertensive Agents; Arginine; Blood Pressure; Body Weight; Cardiovascular System; Chelating Agents; Combined Modality Therapy; Enalapril; Female; Hypertension; Lactation; Lead; Lead Poisoning; Male; Pregnancy; Prenatal Exposure Delayed Effects; Rats, Wistar; Succimer; Time Factors; Treatment Outcome

Topics: Antidotes; Antihypertensive Agents; Blood Pressure; Carbamazepine; Chelating Agents; Child; Child Behavior; Female; Humans; Hypertension; Mercury Poisoning, Nervous System; Succimer; Treatment Outcome

Mercury intoxication is an uncommon cause of hypertension in children and can mimic several other diseases, such as pheochromocytoma and vasculitis. Mercury intoxication can present as a diagnostic challenge because levels of catecholamines may be elevated, suggesting that the etiology is a catecholamine-secreting tumor. Once acrodynia is identified as a primary symptom, a 24-hour urine mercury level can confirm the diagnosis. Inclusion of mercury intoxication in the differential diagnosis early on can help avoid unnecessary and invasive diagnostic tests and therapeutic interventions. We discuss a case of mercury intoxication in a 3-year-old girl presenting with hypertension and acrodynia, without a known history of exposure. Chelation therapy successfully treated our patient's mercury intoxication. However, it was also necessary to concurrently treat her hypertension and the pain associated with her acrodynia. Because there were no known risk factors for mercury poisoning in this case, and because ritual use of mercury is common in much of the United States, we recommend high clinical suspicion and subsequent testing in all cases of acrodynia.

Topics: Abdominal Pain; Acrodynia; Air Pollution, Indoor; Catecholamines; Chelating Agents; Chelation Therapy; Child, Preschool; Environmental Exposure; Exanthema; Female; Humans; Hypertension; Mercury Compounds; Succimer; Tachycardia

Topics: Chelating Agents; Child; Humans; Hyperhidrosis; Hypertension; Male; Mercury; Mercury Poisoning, Nervous System; Neuralgia; Neurologic Examination; Paresthesia; Siblings; Succimer

A 2-year-old girl presented with hypertension, anorexia and vomiting, restlessness, insomnia and acrodynia. Her blood pressure upon arrival was 145/98 mmHg. Ultrasound of the abdomen, CT scan of chest, abdomen and pelvis, and echocardiogram, were normal. Urinary levels of catecholamines were elevated, urine level of mercury was found to be high (33.2 microg/g creatinine), although blood level was normal (>0.5 microg/dl, reference value 0-4 microg/dl). Following a 1-month course of oral treatment with dimercaptosuccinic acid (DMSA) the child's symptoms and signs resolved, and urinary mercury and catecholamines levels normalized. Mercury intoxication should be suspected in a patient with severe hypertension, personality changes and acrodynia. Normal blood levels of mercury do not exclude this diagnosis, and catecholamine levels may serve as a surrogate marker for confirmation of the diagnosis and to evaluate response to treatment.

Topics: Acrodynia; Antidotes; Biomarkers; Catecholamines; Chelating Agents; Child, Preschool; Female; Humans; Hypertension; Mercury; Mercury Poisoning; Succimer; Treatment Outcome

We report a girl with extra-adrenal pheochromocytoma complicated with impaired renal function of the ipsilateral kidney, discussing aetiologies. A 14-year-old girl presented with uncontrolled hypertension, high urinary vanillylmandelic acid level and a 5 x 6 cm mass at the right renal hilum. Her blood pressure was under control with propranolol, prazosin, and nifedipine before surgery, and with sodium nitroprusside during surgical intervention. The total tumour removal required reconstruction of the right renal vein. Histopathology confirmed pheochromocytoma. Dimercaptosuccinic acid (DMSA) after surgery showed low uptake of isotope by the right kidney; it was unclear if this was due to the surgery or the tumour causing renal artery stenosis, but fortunately her blood pressure returned to normal thereafter. We recommend obtaining a DMSA in the preoperative evaluation of pheochromocytoma.

Topics: Adolescent; Adrenal Gland Neoplasms; Blood Pressure; Female; Humans; Hypertension; Image Enhancement; Kidney; Kidney Diseases; Kidney Function Tests; Pheochromocytoma; Postoperative Period; Radionuclide Imaging; Succimer; Tomography, X-Ray Computed

Lead (Pb)-induced hypertension is characterized by an increase in reactive oxygen species (ROS) and a decrease in nitric oxide (NO). In the present study we evaluated the effect of L-arginine (NO precursor), dimercaptosuccinic acid (DMSA, a chelating agent and ROS scavenger), and the association of L-arginine/DMSA on tissue Pb mobilization and blood pressure levels in plumbism. Tissue Pb levels and blood pressure evolution were evaluated in rats exposed to: 1) Pb (750 ppm, in drinking water, for 70 days), 2) Pb plus water for 30 more days, 3) Pb plus DMSA (50 mg kg(-1) day(-1), p.o.), L-arginine (0.6%, in drinking water), and the combination of L-arginine/DMSA for 30 more days, and 4) their respective matching controls. Pb exposure increased Pb levels in the blood, liver, femur, kidney and aorta. Pb levels in tissues decreased after cessation of Pb administration, except in the aorta. These levels did not reach those observed in nonintoxicated rats. All treatments mobilized Pb from the kidney, femur and liver. Pb mobilization from the aorta was only effective with the L-arginine/DMSA treatment. Blood Pb concentrations in Pb-treated groups were not different from those of the Pb/water group. Pb increased blood pressure starting from the 5th week. L-arginine and DMSA treatments (4th week) and the combination of L-arginine/DMSA (3rd and 4th weeks) decreased blood pressure levels of intoxicated rats. These levels did not reach those of nonintoxicated rats. Treatment with L-arginine/DMSA was more effective than the isolated treatments in mobilizing Pb from tissues and in reducing the blood pressure of intoxicated rats.

Topics: Animals; Aorta; Arginine; Blood Pressure; Chelating Agents; Drug Therapy, Combination; Femur; Hypertension; Kidney; Lead; Lead Poisoning; Liver; Male; Rats; Rats, Wistar; Succimer

Administration of 100 ppm lead acetate daily for 3 months caused hypertension in Sprague-Dawley rats, with reversal by treatment with 2,3-dimercaptosuccinic acid (DMSA) (0.5% for 2 weeks). Animals from each group were infused sequentially in 30-min intervals with saline (S), L-arginine (Arg), Arg+ superoxide dismutase (SOD), S, and sodium nitroprusside (SNP). Baseline mean blood pressure (MBP) was elevated in lead-treated animals (Pb) compared to that in controls(C), returning toward normal after DMSA (105 +/- 2 mmHg, C, vs 149 +/- 2, Pb, and 124 +/- 1, DMSA, P < 0.001). Infusion of Arg caused a fall in MBP in all animals, normalizing the MBP in Pb-treated animals. SNP caused a greater fall in MBP in all groups of animals, normalizing the MBP in Pb. Measurement of urinary nitrite + nitrate (NOx) by chemiluminescence revealed at baseline a reduced level in Pb, restored to normal by DMSA (6.6 +/- 1.5 nmol/min/100 g BW, C, vs 3.3 +/- 1.7, Pb, P < 0.05, vs 5.8 +/- 2.6, DMSA, P = NS). Infusion of arginine increased urinary NOx in all groups, but to a lesser degree in Pb and DMSA. Assay of plasma malondialdehyde (MDA) by HPLC, as a measure of reactive oxygen species (ROS), was elevated at baseline in Pb, reduced by DMSA (3.6 +/- 0.4 mumol/L, Pb, vs 1.9 +/- 0.2, C, and 1.9 +/- 0.3, DMSA, P < 0.01). In the Pb group, SOD resulted in a significant fall in MDA (2.0 +/- 0.3 mumol/L, SOD, vs 3.1 +/- 0.1, Arg, P < 0.01), but no further fall in MBP or increase in urinary NOx. Thus, hypertension in lead-exposed animals is related to both diminished NO and increased ROS. The elevation in MBP can be ameliorated by additional NO through infusion of substrate arginine or by treatment with the ROS scavenger, DMSA. Lead-exposed animals show enhanced MBP sensitivity to the NO donors, Arg and SNP, but no further response to SOD, despite a reduction in MDA to normal. We speculate that lead-induced hypertension may be caused by one species of ROS which enhances vascular reactivity, and that provision of additional NO acts to scavenge the ROS and/or acts directly as a vasodilator.

Topics: Animals; Arginine; Blood Pressure; Hypertension; Lead; Male; Malondialdehyde; Nitric Oxide; Nitroprusside; Rats; Rats, Sprague-Dawley; Reactive Oxygen Species; Succimer; Superoxide Dismutase

Topics: Adrenal Gland Neoplasms; Chelating Agents; Child, Preschool; Diagnosis, Differential; Humans; Hypertension; Male; Mercury Poisoning; Pheochromocytoma; Succimer; Sweating

Systemic lupus erythematosus (SLE) patients, specially those with antiphospholipid antibodies, have a high incidence of arterial and venous thrombotic manifestations. However, renal infarction has been rarely reported in these patients. The case of a young female with renal infarction, diagnosed by renal arteriography and scintigraphy, and arterial hypertension (AH) is described. In subsequent years she also suffered several cerebrovascular accidents with important neurological sequelae. No evidence of systemic disease was observed at this time. Fourteen years after the renal infarction a diagnosis of SLE was established. Despite therapy with prednisone, acetylsalicylic acid, azathioprine and antihypertensive drugs the progression of the neurological disease led to death. The sudden appearance of severe AH in a young woman with a renal infarction should alert the clinician about a possible underlying renal artery thrombosis in association with SLE and antiphospholipid antibodies.

Topics: Adult; Angiography; Antibodies, Antiphospholipid; Antiphospholipid Syndrome; Brain Ischemia; Fatal Outcome; Female; Humans; Hypertension; Infarction; Kidney; Lupus Erythematosus, Systemic; Radionuclide Imaging; Renal Artery Obstruction; Succimer; Thrombosis

Mercury poisoning is a rare cause of hypertension in children. Urinary excretion sometimes remains low despite severe clinical intoxication.. A 32 month-old girl was admitted with hypertension, tachycardia, apathy, irritability and excessive sweating. Erythromelalgia and neurologic symptoms permitted the diagnosis of acrodynia. Urine mercury remained normal until chelation. Captopril significantly increased urine mercury concentration but failed to improve clinical manifestations. Clinical improvement required infusions of BAL for 5 days then oral dimercaptosuccinic acid for 3 months. Metal vapors originated from the mercury which spilled from a broken thermometer onto the carpet.. Low basal urine mercury could be associated with real mercury poisoning. Small amounts of metal mercury held in a thermometer could produce a high level of mercury vapor leading to intoxication in young children. The binding capacity of metal ions by captopril could be used to increase urine mercury output. Nevertheless, captopril therapy fails to improve acrodynia. Total elimination of mercury requires long-term therapy with BAL or dimercaptosuccinic acid.. An unexpected mode of intoxication and low basal urine mercury are not decisive arguments against mercury poisoning, which is the only cause of acrodynia.

Topics: Administration, Oral; Captopril; Child, Preschool; Dimercaprol; Female; Humans; Hypertension; Injections, Intramuscular; Mercury Poisoning; Succimer

Renoscintigraphy with 99mTc-DMCA with regard to a percentage of an RP uptake by the kidney was performed in 70 patients with uronephrological lesions before operation. A close relationship was established between a percentage of a 99mTc-DMCA uptake by the kidney on the 3rd hour after RP administration and values of the effective renal plasma flow, calculated on the basis of the results of renoscintigraphy with 131I-hippuran. Comparison of the 99mTc-DMCA uptake percentage values on the 3rd and 24th hours in patients with marked lesions of renal tubular functions has shown a high degree of correlation, permitting the recommendation of quantitative renoscintigraphy on the 3rd hour. Analysis of the specific percentage of the RP uptake, calculated for 1 cm2 of the visualized renal parenchyma, makes it possible to increase on the average by 29% the detection of renal function in uronephrological patients.

Topics: Adult; Humans; Hypertension; Iodohippuric Acid; Kidney Diseases; Kidney Tubules; Organotechnetium Compounds; Radioisotope Renography; Renal Circulation; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

Aim of the study was to evaluate the renal responses to physical and mental effort in essential hypertension by means of a non-invasive radioisotopic method. Renal uptake rate of Tc99m-DMSA was evaluated in 10 subjects. Starting from 5 to 15 minutes after dose injection counts over the kidney region were acquired by means of a gamma-camera time-activity curves were obtained for each kidney. In non-stimulated patients DMSA uptake rate increased regularly; in the remaining cases both isometric exercise and mental effort induced an abrupt reduction of the uptake rate which increased again after the end of the test. Although the relation of DMSA uptake rate to renal function is not yet fully understood, we tentatively interpret these results as indicating blood flow reductions during these stressful conditions.

Topics: Humans; Hypertension; Kidney; Organometallic Compounds; Physical Exertion; Renal Circulation; Rest; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thinking