Abstract:

Objective To analyze the clinical features and prognosis of hypertensive encephalopathy (HE) in children according to different potential causes. Methods The clinical data of children diagnosed with HE from January 1, 2011 to May 31, 2023 were retrospectively analyzed. According to the etiology, the children were divided into renal hypertension group and non-renal hypertension group, and the clinical features between the two groups were compared. Results A total of 24 children with HE (12 boys and 12 girls) were included, with a median age of 9.0 (7.0-12.0) years. The average systolic blood pressure was (167.1±21.4) mmHg, with a systolic pressure index of 1.5±0.2. The average diastolic blood pressure was (114.3±12.3) mmHg, with a diastolic pressure index of 1.6±0.2. The primary underlying diseases included nephrotic syndrome (3 cases), lupus nephritis (3 cases), IgA nephropathy (3 cases), and acute lymphoblastic leukemia (3 cases). Abnormalities on cranial MRI were observed in 21 children (87.5%), with 20 children showing typical lesions of posterior reversible encephalopathy syndrome (PRES) and 1 child exhibiting supratentorial hydrocephalus. Compared with the non-renal hypertension group, the renal hypertension group had a higher age, higher systolic blood pressure, higher systolic blood pressure index, higher diastolic blood pressure, higher neurological symptom score, higher incidence of nausea and vomiting, and higher incidence of epilepsy, as well as lower serum total protein and albumin levels, with statistically significant differences (P<0.05). The scores of neurological symptoms exhibited a significant positive correlation with age, systolic blood pressure, and systolic pressure index (P<0.01). The average follow-up duration for all children was (25.8±4.1) months. One child diagnosed with lupus nephritis experienced a decline in memory and calculation abilities within six months after the onset of HE. The remaining 23 children showed symptom relief following treatment with antiepileptic and antihypertensive medications, and no abnormal findings were noted during the follow-up period. Conclusions The clinical symptoms of children with renal hypertension are more severe than those of children with non-renal hypertension. Additionally, if children with renal hypertension experience sudden seizures, HE should be highly suspected, and timely antihypertensive treatment should be administered to improve the prognosis.

Key words: hypertensive encephalopathy, renal hypertension, child