Related Experiment Videos
Evaluation and long-term outcome of pediatric renovascular hypertension
S J McTaggart1, S Gulati, R G Walker
1Victorian Paediatric Renal Services, Royal Children's Hospital, Parkville, Australia.
Insights
Surgical reconstructive procedures offer excellent long-term outcomes for children with renovascular hypertension, with 50% cured and 30% improved. Neurofibromatosis was the most frequent cause in this study.
Area of Science:
- Pediatric Nephrology
- Vascular Surgery
- Pediatric Hypertension
Background:
- Renovascular hypertension in children is a severe condition requiring specialized management.
- Neurofibromatosis is a significant etiology, unlike Takayasu's arteritis, in pediatric renovascular hypertension cases.
- Diagnosis necessitates comprehensive investigations, with renal angiography being crucial for definitive assessment and therapeutic planning.
Purpose of the Study:
- To evaluate the management and long-term outcomes of pediatric renovascular hypertension.
- To assess the efficacy of different treatment modalities, including surgical reconstruction and percutaneous transluminal angioplasty.
Main Methods:
- Retrospective analysis of 17 children with renovascular hypertension managed between 1975 and 1996.
- Review of diagnostic investigations including renal angiography.
- Evaluation of surgical interventions: percutaneous transluminal angioplasty, vascular reconstructive procedures (bypass grafts, autotransplantation).
Main Results:
- Severe hypertension was present at presentation (mean SBP 7 SD, DBP 5.5 SD above age-matched averages).
- Neurofibromatosis accounted for 58% of cases; Takayasu's arteritis was absent.
- Surgical reconstructive procedures achieved cure in 50% and improvement in 30% of patients, with excellent long-term outlook and no restenosis at mean follow-up of 11 years.
- Percutaneous transluminal angioplasty had limited success, with cure in only one of four patients.
Conclusions:
- Surgical reconstructive procedures provide durable and effective treatment for pediatric renovascular hypertension.
- Early and accurate diagnosis via renal angiography is vital for successful management.
- Long-term follow-up confirms the excellent prognosis following successful surgical intervention.
Abstract:
Seventeen children with renovascular hypertension were managed at the Royal Children's Hospital, Melbourne, over the 20-year period from 1975 to 1996. The age at presentation ranged from 10 days to 18 years. All children presented with severe hypertension with mean systolic blood pressure 7 standard deviations above age-matched averages and mean diastolic blood pressure 5.5 standard deviations above age-matched averages. Neurofibromatosis was the most common etiology (58% of patients) and there were no cases of Takayasu's arteritis. Patients underwent a variety of biochemical and imaging investigations but in all cases renal angiography was necessary for definitive diagnosis and for planning therapy. Ten of the 17 patients had surgical procedures performed. Percutaneous transluminal angioplasty was performed in four patients but led to cure in only one patient following thrombosis of the affected artery producing segmental renal infarction. Other vascular reconstructive procedures, including the use of autologous or synthetic bypass grafts and autotransplantation, produced cure of hypertension in 50% of children with improvement in a further 30%. The long-term outlook for children treated with surgical reconstructive procedures was excellent. One patient underwent surgery for avulsion of an arterial graft following a pubertal growth spurt. No other patient originally cured by surgery has required reoperation with no cases of restenosis at a mean follow-up of 11 years 3 months.