Related Experiment Videos
[Renal artery pathology and its therapeutic indications in the child]
G Deschenes1, M Zitek, M C Gubler
1Service de Néphrologie Pédiatrique, Hôpital Necker, Enfants Malades, Paris.
Insights
Pediatric renovascular hypertension due to renal artery occlusive disease requires surgical intervention. Renal revascularization achieved normal blood pressure in 40% of patients, with nephrectomy offering an alternative cure.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery
- Vascular Disease
Context:
- Renovascular hypertension in children is a serious condition often caused by renal artery occlusive disease.
- Management strategies have evolved over decades, with surgical intervention playing a key role.
- Diverse etiologies contribute to pediatric renovascular hypertension, including fibromuscular dysplasia and neurofibromatosis.
Purpose:
- To review the management and outcomes of pediatric patients with renovascular hypertension caused by renal artery occlusive disease.
- To analyze the effectiveness of surgical revascularization and nephrectomy in treating this condition.
- To identify the causes and success rates of different surgical procedures.
Summary:
- A cohort of 94 pediatric patients (4 days to 17 years) with renovascular hypertension was analyzed retrospectively (1955-1990).
- Common causes included neurofibromatosis, fibromuscular dysplasia, and renal artery thrombosis.
- Surgical treatment involved 47 renal revascularizations (e.g., bypass, reimplantation) with a 32% failure rate, and 25 successful nephrectomies.
Impact:
- Renal revascularization successfully normalized blood pressure in 40% of pediatric patients.
- Nephrectomy provided a cure for an additional 25 patients, highlighting its importance in management.
- Understanding the outcomes of surgical interventions informs treatment strategies for pediatric renovascular hypertension.
Abstract:
Between September 1955 and January 1990, 94 pediatric patients were managed for renovascular hypertension caused by renal artery occlusive disease. Patients (50 boys and 44 girls) were aged 4 days to 17 years (median age: 7 years). At initial evaluation, 34 patients had symptoms of hypertensive encephalopathy or acute heart failure, 36 had moderate symptoms, and 24 were symptom-free. Sixty-five cases were classified on the basis of clinical, radiological, and histological features, as follows: neurofibromatosis (17), fibromuscular dysplasia (11), diffuse arterial calcified elastopathy (11), renal artery thrombosis (10), Williams syndrome (4), Takayashu disease (3), and miscellaneous diseases (9). In the 29 remaining patients, classification was based only on radiological features: causes included unilateral renal artery stenosis (15), bilateral renal artery stenosis with or without aortic stenosis (11), and miscellaneous disorders (3). Surgical treatment consisted in 47 renal revascularization, procedures (14 aortorenal bypasses, 8 aortorenal reimplantations, 9 anastomoses in the upper mesenteric arterial system, 7 autotransplantations, 4 resection-reanastomosis procedures, and 5 miscellaneous procedures). Renal revascularization failed in 15 cases (32%) (because of thrombosis in 14 cases and dehiscence in one). Residual or recurrent stenosis was seen in 7 arteries, whereas the anatomic result was satisfactory in 25 arteries (53%). Blood pressures returned to normal in 16 of 40 (40%) patients successfully treated by revascularization. An additional 25 patients recovered normal blood pressure values after primary nephrectomy (21), partial nephrectomy (4) or nephrectomy after failed renal revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)