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Résumé: La maladie de Takayasu (MT) est une maladie inflammatoire chronique oblitérante des grosses artères, qui se complique rarement d'hypertension artérielle maligne (HTAm), particulièrement chez les enfants et les adolescents. Nous rapportons le cas d'un jeune patient de 20 ans avec HTAm et vascularite prédominante aux troncs supra-aortiques. Takayasu disease is a chronic inflammatory and obliterative disease of large arteries. It is rarely complicated by malignant hypertension, especially in the paediatric and adolescent age group. Here we present a case of 20-year-old adolescent with Takayasu arteritis who presented with malignant hypertension and multiple vessel involvement predominated in aortic arch vessel. [ABSTRACT FROM AUTHOR]

Résumé Introduction L’hypertension artérielle maligne (HTAm), en pédiatrie, est particulière par sa présentation clinique, définie par une HTA sévère accompagnée d’une défaillance ischémique d’un ou plusieurs organes. Méthodes-patients Étude rétroprospective des dossiers d’enfants admis en réanimation pédiatrique. Nous avons choisi un recul de 10 ans allant de septembre 1994 à décembre 2004 pour la première période, et de janvier 2005 à décembre 2015 pour la seconde période ; et nous avons relevé les observations ayant présenté une HTAm. Résultats Soixante-six patients ont été inclus, une prévalence de 0,6 %. L’âge des patients varie de 12 mois à 16 ans. Les symptômes sont liés aux conséquences de l’HTA ou à l’affection en cause. Les signes les plus retrouvés sont des céphalées dans plus de 7 %. Un évènement vasculaire cérébral chez 6 % patients. Une encéphalopathie hypertensive convulsivante chez 33,3 %. L’atteinte rénale est commune, de sévérité variable. Un fond d’œil a retrouvé des rétinopathies stade 3 chez 47 %, stade 4 chez 51 %. L’HTAm définie pour des valeurs de PAS moyenne de 175 mmHg et de PAD moyenne de 112,5 mmHg est secondaire souvent à une cause rénale. Le traitement est symptomatique comportant des antihypertenseurs associé au traitement étiologique. L’évolution est bonne en dehors de 7 décès. Conclusion HTAm est une affection rare dans la population pédiatrique. La symptomatologie clinique est riche de signes fonctionnels qui relèvent de leur retentissement sur les organes vitaux. La prise en charge doit être précoce en soins intensifs. Introduction Malignant hypertension (HTA), pediatrics, is unique by its clinical presentation, defined as severe hypertension accompanied by ischemic failure of one or more organs. Methods-patients Retroprospective study of cases of children admitted to pediatric intensive care. We chose a decline of 10 years from September 1994 to December 2004 for the first time, and from January 2005 to December 2015 for the second period; and we identified the cases presenting malignant hypertension (mHTA). Results Sixty-six patients were included, a prevalence of 0.6%. The age of patients ranged from 12 months to 16 years. The symptoms are related to the consequences of hypertension or condition in question. The most found signs are headache in more than 7%. Cerebrovascular event in 6%. A hypertensive convulsive encephalopathy 33.3% of patients. Renal disease is common, of varying severity. A fundus retinopathy was found in 47% stage 3, stage 4 in 51%. mHTA defined for the mean SBP values of 175 mmHg and DBP average 112,5 mmHg is often secondary to renal causes. The treatment is symptomatic with antihypertensive associated with the etiological treatment. Evolution is good out of 7 deaths. Conclusion mHTA is a rare condition in the pediatric population. The clinical signs of functional rich under their impact on vital organs. The support must be early in intensive care. [ABSTRACT FROM AUTHOR]

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Our purpose is to report a clinical case of bilateral macular edema caused by malignant hypertension in a 35-year old male. Patient presented with bilateral low visual acuity, massive macular edema, retinal hemorrhages and papilledema. Soon after he was diagnosed with other target-organ lesions, on heart and kidneys. After months of controlled blood pressure, an increase in visual acuity and a small decrease of macular edema, we effectively treated the lower vision eye with two intravitreal ranibizumab 0,5 mg injections, improving anatomy and function on both eyes. Even though we only treated one eye with ranibizumab, the contralateral eye also improved visual acuity and central macular thickness. This probably happened due to systemic absorption of ranibizumab. To the best of our knowledge, this is the first report of ranibizumab use in macular edema due to malignant hypertension.

Reninoma or juxtaglomerular cell tumor is a rare usually benign renal renin secreting tumor. We report the case of an 18-year old woman, without any medical history, investigated in our hospital's emergency department for a bilateral papilledema. Ambulatory ophthalmological investigations were performed because of a newly occurring blurry vision, associated with diffuse headaches. Cerebral mRI and lumbar puncture recommended by the ophthalmologist and neurologist excluded intra-cranial hypertension. The patient presented with severe hypertension. Laboratory values showed hypokalemia, compensated metabolic alkalosis and microalbuminuria. During the hospital stay, she developed AKIN 1 acute renal injury. Ultrasound revealed a tissular cystic lesion of the superior pole of the right kidney. Abdominal mRI confirmed the lesion and raised suspicion for a renal cell carcinoma without calicial or vascular invasion. Plasma renin value was >500 mUI/L with normal values for plasma aldosterone. Renal biopsy diagnosed a juxtaglomerular cell tumor. After an aggressive initial treatment, hypertension remained well controlled with spironolactone only, finally allowing for withdrawal of all antihypertensive medications. Robot-assisted laparoscopic partial nephrectomy was performed. Studies of the operative specimen confirmed the diagnosis of benign reninoma. Clinical follow-up showed complete resolution of clinical and biological parameters., (Copyright © 2021 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)