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Renal Doppler evaluation in the child with hypertension: a reasonable screening discriminator?
Sumit Chhadia1, Richard A Cohn, Gulsah Vural
1Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA.
Insights
Doppler ultrasound (US) is a useful screening tool for detecting renal artery stenosis in hypertensive children. Clinical risk assessment helps determine which children need arteriography, even if Doppler US is negative.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
Background:
- Hypertension affects 1-5% of children, with 5-10% having renovascular disease.
- Renal artery stenosis is a key cause of secondary hypertension in children.
- Arteriography is the gold standard for diagnosing renal artery stenosis, while Doppler US is a recommended screening method.
Purpose of the Study:
- To assess the effectiveness of Doppler US in screening for renal artery stenosis in children.
- To identify clinical features that indicate the need for arteriography in hypertensive children.
Main Methods:
- Retrospective analysis of 62 children with hypertension evaluated over 12 years.
- Inclusion criteria: renal US with Doppler followed by arteriography.
- Hypertension severity classified as mild, moderate, or severe.
Main Results:
- Doppler US detected 11 of 17 cases of renal artery stenosis (64% sensitivity).
- Six cases were missed by Doppler US, including four with segmental artery lesions.
- 79% of children with confirmed renal artery stenosis had moderate to severe hypertension.
Conclusions:
- Doppler US is a valuable screening tool for identifying renal artery stenosis in hypertensive children.
- Clinical risk stratification aids in selecting patients for arteriography.
- Combining Doppler US with clinical assessment optimizes the diagnostic pathway for pediatric renovascular hypertension.
Background:
Hypertension is diagnosed in 1-5% of children, and 5-10% of those hypertensive children have renovascular disease. The gold standard for a diagnosis of renal artery stenosis is arteriography, and Doppler ultrasound (Doppler US) continues to be advocated as a useful screening test.
Objective:
The purpose of this study was to determine the utility of Doppler US in children as a screening tool and to better define clinical features of children in whom arteriography should be performed.
Materials And Methods:
This retrospective study evaluated the imaging and clinical parameters for all children who had a renal US with Doppler followed by a diagnostic arteriogram for the evaluation of hypertension during a 12-year period at a tertiary children's hospital. Sixty-two children were included. We evaluated each child's clinical parameters and placed each child into one of three categories of hypertension: mild, moderate or severe.
Results:
Eleven of 17 kidneys with proven renal artery stenosis were detected with Doppler US (sensitivity 64%). Six children with renal artery stenosis were missed by Doppler US, four of whom had segmental artery lesions. Of the children with positive renal artery stenosis on arteriography, all but three (79%) were classified as having moderate to severe hypertension.
Conclusion:
Doppler US is a useful screening examination when evaluating children with hypertension, detecting renal artery stenosis in most affected children. The clinical risk classifications are helpful in guiding which children should proceed with arteriography regardless of the Doppler US results.
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Preparation of Equipment:
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Monitoring Both Arms:
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