Investigation of the frequency of hypertension and cardiac affection in children with renal scar detected in DMSA

Urinary tract infections, which are common in childhood, are among the most important causes of renal scarring. In particular, 8.4% of girls and 1.4% of boys experience urinary tract infections in the first six months of their lives. Febrile infections increase the risk of renal parenchymal involvement, and this involvement leads to inflammation, nephron damage, and permanent parenchymal damage. Factors such as VUR, recurrent infections, delay in antibiotic treatment, and genetic predisposition play an important role in renal scarring. Factors such as vesicourethral reflux (VUR), recurrent infections, delay in antibiotic treatment and genetic predisposition play an important role in renal scar formation. The frequency of VUR in children with recurrent urinary tract infections varies between 30-50%, and renal scarring is observed in 30% of these cases. Renal scarring can lead to complications such as glomerulosclerosis, proteinuria and hypertension. Microalbuminuria is considered an early indicator of renal damage and may be a sign of future renal dysfunction. Renal scarring has generally been associated with high blood pressure, but more comprehensive studies are needed on the frequency and timing of this condition. The aim of this study was to evaluate the prevalence of hypertension in children with renal scars detected on DMSA scintigraphy and the rate of cardiac involvement in these children. In addition, to contribute to the development of early diagnosis and follow-up strategies in these children by examining the relationship between hypertension and clinical parameters and demographic factors. This study was a retrospective study of patients aged 1-18 years who underwent DMSA scintigraphy between January 2020 and January 2024 at the Children's Clinic of Fırat University Hospital. Patients with renal scarring and a history of Recurrent UTI, Renal Hypoplasia, Renal Agenesis, Multicystic Kidney or Horseshoe Kidney were included in the study. Patients with incomplete file records were excluded from the study. Patient data were obtained from the hospital registry system, and hypertension frequency and cardiac involvement were evaluated with blood pressure holter and echocardiography. The obtained data were analyzed and the study results were created. The demographic characteristics, clinical values and blood pressure parameters of children with scarring were examined in the study. While the majority of children were not obese, it was determined that their socioeconomic status was generally moderate and that there was a rare history of hypertension in their families. In clinical evaluations, blood pressure values were generally within normal limits, but diastolic blood pressure was high in some children. Small differences were found in terms of blood pressure values between children with and without recurrent urinary tract infections, but no statistically significant relationships were found between general blood pressure status. Low-level relationships were found between blood pressure values and some biochemical parameters. In addition, significant differences were found between the control and experimental groups in the study in terms of IVSD, IVSS, EF and RWT values. Patients in the control group had higher values than patients in the experimental group. However, the differences between the groups in the AODIA, LADIA, LVIDD, LVIDS, EDV, ESV, SV and FS% parameters were not significant. These results indicate that more comprehensive studies are needed to better understand the effects of renal diseases on cardiac parameters. Our study; as a result of our observations, larger and longer-term studies are needed to understand the relationship between renal diseases and hypertension in children. Routine night blood pressure measurements are important for early detection of mask hypertension and reduction of cardiovascular risks. Children with renal disease should undergo regular cardiological follow-ups. In this study, it was predicted that children with renal scarring might experience disruption in dippers and diastolic hypertension (HT), and that HT could develop in the later stages.