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Changes in arterial pressure and markers of nitric oxide homeostasis and oxidative stress following surgical correction of hydronephrosis in children

  • Al-Mashhadi, Ammar1
  • Checa, Antonio2
  • Wåhlin, Nils3, 4
  • Neveus, Tryggve5
  • Fossum, Magdalena3, 4
  • Wheelock, Craig E.2
  • Karanikas, Birgitta1
  • Stenberg, Arne1
  • Persson, A. Erik G.6, 7
  • Carlstrom, Mattias7
  • 1 Uppsala University, Pediatric Surgery Section, Department of Women’s and Children’s Health, Uppsala, Sweden , Uppsala (Sweden)
  • 2 Karolinska Institutet, Department of Medical Biochemistry and Biophysics, Stockholm, Sweden , Stockholm (Sweden)
  • 3 Karolinska Institutet, Department of Women’s and Children’s Health, and Center for Molecular Medicine, Stockholm, Sweden , Stockholm (Sweden)
  • 4 Karolinska University Hospital, Department of Pediatric Surgery, Astrid Lindgren Children’s Hospital, Stockholm, Sweden , Stockholm (Sweden)
  • 5 Uppsala University, Pediatric Nephrology Unit, Department of Women’s and Children’s Health, Uppsala, Sweden , Uppsala (Sweden)
  • 6 Uppsala University, Department Medical Cell Biology, Uppsala, Sweden , Uppsala (Sweden)
  • 7 Karolinska Institutet, Department of Physiology and Pharmacology, Nanna Svartz Väg 2, Stockholm, 17177, Sweden , Stockholm (Sweden)
Published Article
Pediatric Nephrology
Publication Date
Dec 01, 2017
DOI: 10.1007/s00467-017-3848-4
Springer Nature


ObjectiveRecent clinical studies have suggested an increased risk of elevated arterial pressure in patients with hydronephrosis. Animals with experimentally induced hydronephrosis develop hypertension, which is correlated to the degree of obstruction and increased oxidative stress. In this prospective study we investigated changes in arterial pressure, oxidative stress, and nitric oxide (NO) homeostasis following correction of hydronephrosis.MethodsAmbulatory arterial pressure (24 h) was monitored in pediatric patients with hydronephrosis (n = 15) before and after surgical correction, and the measurements were compared with arterial pressure measurements in two control groups, i.e. healthy controls (n = 8) and operated controls (n = 8). Markers of oxidative stress and NO homeostasis were analyzed in matched urine and plasma samples.ResultsThe preoperative mean arterial pressure was significantly higher in hydronephrotic patients [83 mmHg; 95% confidence interval (CI) 80–88 mmHg] than in healthy controls (74 mmHg; 95% CI 68–80 mmHg; p < 0.05), and surgical correction of ureteral obstruction reduced arterial pressure (76 mmHg; 95% CI 74–79 mmHg; p < 0.05). Markers of oxidative stress (i.e., 11-dehydroTXB2, PGF2α, 8-iso-PGF2α, 8,12-iso-iPF2α-VI) were significantly increased (p < 0.05) in patients with hydronephrosis compared with both control groups, and these were reduced following surgery (p < 0.05). Interestingly, there was a trend for increased NO synthase activity and signaling in hydronephrosis, which may indicate compensatory mechanism(s).ConclusionThis study demonstrates increased arterial pressure and oxidative stress in children with hydronephrosis compared with healthy controls, which can be restored to normal levels by surgical correction of the obstruction. Once reference data on ambulatory blood pressure in this young age group become available, we hope cut-off values can be defined for deciding whether or not to correct hydronephrosis surgically.

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