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Renovascular hypertension in children
Scandinavian Journal of Urology and Nephrology
|January 5, 2002
Summary
Renovascular hypertension (RVH) in children, though uncommon, is a significant cause of severe hypertension. Early diagnosis and tailored treatment, including surgery or angioplasty, lead to successful outcomes in carefully selected pediatric patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Medicine
- Medical Imaging
Background:
- Renovascular hypertension (RVH) is a critical condition in children, often presenting with severe hypertension.
- Early identification and management are crucial for long-term patient outcomes.
Purpose of the Study:
- To investigate the causes, clinical presentation, diagnostic methods, treatment strategies, and outcomes of pediatric renovascular hypertension.
- To evaluate the effectiveness of various interventions for RVH in children.
Main Methods:
- A retrospective study of 20 children diagnosed with RVH between 1977 and 1998.
- Diagnosis involved aortography, with additional use of post-captopril renography, Doppler ultrasonography, and spiral computed tomography angiography.
- Treatment modalities included surgery, percutaneous transluminal angioplasty (PTA), and antihypertensive medications.
Main Results:
- Hypertension was often detected during routine examinations or presented as heart failure/hypertensive encephalopathy.
- Common causes included fibromuscular dysplasia, middle aortic syndrome, neurofibromatosis, and William's syndrome.
- At follow-up, a significant majority of patients achieved normotension with or without medication; however, three patients died.
Conclusions:
- Renovascular disease is a frequent, albeit sometimes asymptomatic, cause of severe childhood hypertension.
- Non-invasive imaging techniques are valuable for screening RVH in pediatric populations.
- Surgical or PTA interventions are successful when applied to carefully selected patients with RVH.