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[Renovascular hypertension in children]
1Katedry i Kliniki Nefrologii Pediatrycznej AM we Wrocławiu.
Insights
Renovascular hypertension (RVH) is more prevalent in children than adults, often caused by fibromuscular dysplasia or renal artery thrombosis. Early diagnosis and tailored treatments like angioplasty or surgery improve outcomes in pediatric RVH.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Medicine
- Medical Diagnostics
Background:
- Renovascular hypertension (RVH) affects 5-25% of hypertensive children, significantly higher than the <1% seen in adults.
- Common pediatric causes include fibromuscular dysplasia (60%) and neonatal renal artery thrombosis post-catheterization.
- Many children with RVH are asymptomatic, with hypertension detected during routine check-ups.
Discussion:
- Diagnostic suspicion for RVH in children arises from history, physical exam, and lab analysis, excluding other hypertension causes.
- Contemporary diagnostic methods are age-dependent and consider renal artery abnormality location and extent.
- Angiotensin-converting enzyme inhibition scintigraphy is crucial for diagnosing RVH in newborns and infants.
Key Insights:
- Fibromuscular dysplasia is the leading cause of RVH in children.
- Renal artery thrombosis is a primary cause in neonates following umbilical artery catheterization.
- Early detection through routine screening is vital as many children remain asymptomatic.
Outlook:
- Therapeutic options include surgery, percutaneous transluminal renal angioplasty (PTRA), and pharmacologic treatment.
- Surgical interventions and PTRA show promising amelioration of effects.
- Individualized therapy is essential due to potential resistance to conservative treatment and treatment-related complications.
Abstract:
Renovascular hypertension (RVH) is more commonly diagnosed in children than in adults. The prevalence of RVH in unselected hypertensive adults is < 1%, compared with 5-25% in children. The most common cause RVH in childhood is fibromuscular dysplasia, which is reported in 60% of patients, but in the neonatal period renal artery thrombosis after umbilical artery catheterization is the main cause of hypertension. Most of RVH children have no symptoms when an increased blood pressure is detected during routine examination. Special diagnostic procedures are allowed only when suspicion of RVH is based on history data, physical examination and laboratory analysis and other possible reasons of hypertension were excluded. The paper describes contemporary diagnostic methods and their usefulness in revealing RVH in children, depending on their age, location of abnormalities in renal arteries and their extent. The significance of angiotensin converting enzyme inhibition scintirenography in diagnosing of RVH in newborns and infants is exposed. Current therapeutic abilities, such as surgical procedures, percutaneous transluminal renal angioplasty and pharmacological treatment, are also shown. The attention is called to amelioration in effects after operations and PTRA. The stress is also put on resistance to conservative treatment and possible complications due to therapy. The necessity of individual therapy is underlined.