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Favorable outcome of neonatal aortic thrombosis and renovascular hypertension
M S Caplan1, R A Cohn, C B Langman
1Department of Pediatrics, Northwestern University Medical School, Chicago, IL.
Insights
Children with renovascular hypertension due to aortic thrombosis showed improved outcomes. Most achieved normal blood pressure and renal function, with some requiring medication for hypertension in early childhood.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery
- Medical Imaging
Background:
- Renovascular hypertension in neonates can result from aortic thrombosis.
- This condition presents with hypertension and elevated plasma renin activity.
- Long-term outcomes for affected children require further investigation.
Purpose of the Study:
- To determine the long-term outcome of children with renovascular hypertension secondary to aortic thrombosis.
- To assess renal function, blood pressure, and growth in this patient cohort.
- To evaluate the impact of neonatal antihypertensive therapy on later renal perfusion.
Main Methods:
- Follow-up study of 15 children diagnosed with renovascular hypertension from aortic thrombosis.
- Assessment included clinical evaluation, antihypertensive medication use, statural growth, and laboratory tests (serum creatinine, plasma renin activity, glomerular filtration rate).
- Radionuclide renography and scintigraphy were used to evaluate renal blood flow in 11 patients.
Main Results:
- All children became normotensive at follow-up; five required medication for hypertension during infancy.
- 14 out of 15 children exhibited normal statural growth.
- Renal function tests (creatinine, renin activity, GFR) were normal in all patients. Radionuclide studies showed improved renal perfusion in most, though unilateral absence of perfusion resulted in functionally anephric kidneys.
Conclusions:
- Children with renovascular hypertension due to aortic thrombosis can achieve good renal function and normal growth.
- Aggressive neonatal antihypertensive therapy appears to contribute to positive long-term outcomes.
- Improved renal perfusion is observed in many patients, even those with initial perfusion deficits.
Abstract:
Fifteen children with renovascular hypertension as a result of aortic thrombosis were followed for a mean of 26 months (range 5 to 58 months) to determine outcome. As neonates, all patients had hypertension and elevated plasma renin activity. Of 11 patients studied with radionuclide renography and scintigraphy, 10 had abnormal renal blood flow; three had complete absence of unilateral perfusion. On follow-up examination all children were normotensive; five children ages 5 to 24 months required antihypertensive medication. Of 15 children, 14 had normal statural growth; all had normal serum creatinine, plasma renin activity, and calculated glomerular filtration rate values. Patients with complete absence of renal perfusion unilaterally remained functionally anephric; children with less severe perfusion deficits had improved perfusion as shown by radionuclide renography and scintigraphy. We believe that many patients with aortic thrombosis and renovascular hypertension who have had aggressive antihypertensive therapy in the neonatal period will have good renal function and increased perfusion to the affected kidney 2 years later.