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Renovascular hypertension: a case with atypical neurological signs

Mónica Jerónimo1, Teresa Dionísio2, Clara Gomes3

  • 1Hospital Pediátrico de Coimbra, Coimbra, Portugal.

BMJ Case Reports
|September 10, 2015
PubMed

Insights

Severe hypertension in a 13-month-old boy, caused by bilateral renal artery stenosis, was successfully treated with balloon dilation. This intervention improved blood pressure and reversed target organ damage, highlighting a key treatment for pediatric renovascular hypertension.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Medicine
  • Interventional Radiology

Background:

  • Secondary hypertension is common in children, with renovascular disease being a significant cause, particularly in severe, medically refractory cases.
  • Uncontrolled hypertension in pediatric patients can lead to critical target organ damage.

Observation:

  • A 13-month-old infant presented with failure to thrive, lower extremity weakness, and irritability.
  • The infant experienced a hypertensive emergency refractory to multiple antihypertensive medications.

Findings:

  • Renal angiography revealed bilateral renal artery stenosis as the cause of the severe hypertension.
  • Successful balloon angioplasty of the renal arteries led to a significant reduction in blood pressure.

Implications:

  • This case underscores the importance of suspecting and diagnosing renovascular disease in pediatric hypertensive emergencies.
  • Interventional treatment, such as balloon dilation, can be highly effective in managing pediatric renovascular hypertension and preventing long-term complications.
  • While blood pressure and organ damage improved, persistent lower extremity weakness suggests potential neurological sequelae requiring further investigation.

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