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Hypertension and segmental renal infarction in children: apropos of two cases

Júlia Candel-Pau1, Yolanda Castilla-Fernández, Alvaro Madrid-Aris

  • 1Department of Pediatric Nephrology, Hospital Vall d'Hebron, Barcelona, Spain. julicpvs@hotmail.com

Pediatric Nephrology (Berlin, Germany)
|February 22, 2008
PubMed

Insights

Segmental renal infarction (SRI) is a rare cause of pediatric renovascular hypertension (RVH). This study details two children with idiopathic SRI, highlighting diagnosis and varied treatment approaches for this uncommon condition.

Area of Science:

  • Pediatric Nephrology
  • Vascular Surgery
  • Hypertension Research

Background:

  • Renovascular hypertension (RVH) accounts for 8-10% of pediatric hypertension cases.
  • Segmental renal infarction (SRI) is a rare etiology of RVH, often idiopathic.
  • SRI involves occlusion of small renal arteries, leading to hypertension and potential hyponatremia.

Observation:

  • Two pediatric cases of idiopathic SRI presenting with severe arterial hypertension and hyponatremia are described.
  • Hypertension was detected during hematuria workup in one child and as a hypertensive emergency in the other.
  • Both cases involved occlusion of small renal arteries leading to SRI.

Findings:

  • Selective renal arteriography is the gold standard for diagnosing SRI.
  • Treatment varied: one patient underwent partial nephrectomy, while the other received antihypertensive medication due to the infarct location.
  • Surgical segmentectomy is the definitive treatment when feasible.

Implications:

  • This case series underscores the importance of considering rare causes like SRI in pediatric hypertension.
  • Management strategies for SRI should be individualized based on infarct localization and surgical feasibility.
  • Further research into the idiopathic origins and optimal management of SRI in children is warranted.

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