Abstract
Herein, a case of malignant hypertension was reported in a 7 year-old girl, who complained of hypertension (180/130) and nasal bleeding. Right contracted kidney was found on IVP, right renal artery stenosis on renal arteriogram and bilateral vesico-ureteral reflex (VUR) on voiding cystogram. Peripheral vein renin was 11.8 ng/ml/hr, however, there was no lateralization in the value of renal vein renin. Anti-VUR operations were performed and she was followed up with an antihypertensive medication. With a sudden cessation of the antihypertensive drugs (Inderal, Apresolin and Serpasil), hypertension was accelerated (260/180), associated with hematuria, edema and oliguria. Hypertensive encephalopathy appeared during peritoneal dialysis and she died in uremia . At autopsy, malignant nephrosclerosis was noticed and arteriosclerotic vascular changes were found in adrenal glands, liver, spleen and pancreas. This case was supposed to be the seventh case of malignant nephrosclerosis in the Japanese children. Right renovascular hypertension and bilateral pyelonephritis with superimposed acceler ated nephrosclerosis was discussed for the pathogenesis of hypertension in this case.
