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Pediatric renovascular hypertension: Treatment outcome according to underlying disease
Yeonhee Lee1, Young Shin Lim1, Sang Taek Lee2
1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Renovascular hypertension (RVH) in Korean children is often linked to moyamoya disease (MMD). Combined treatments, not just angioplasty, are needed for effective blood pressure control and to prevent organ damage in MMD patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Research
- Neurology
Background:
- Renovascular hypertension (RVH) represents 5-10% of pediatric hypertension cases.
- RVH can be associated with systemic diseases affecting multiple organs.
- Understanding RVH in children is crucial for early diagnosis and management.
Purpose of the Study:
- To evaluate the clinical characteristics of Korean pediatric patients diagnosed with RVH.
- To assess the treatment outcomes for pediatric RVH patients in Korea.
- To identify the primary causes and associated conditions of RVH in this demographic.
Main Methods:
- Retrospective review of medical records for 25 Korean pediatric patients with RVH.
- Analysis of underlying diseases, initial treatments, and interventional procedures.
- Evaluation of treatment outcomes, including blood pressure control and target-organ damage.
Main Results:
- Moyamoya disease (MMD) was the most common underlying condition (40%), with RVH preceding MMD in seven cases.
- All patients initially received antihypertensive medication; 22 underwent percutaneous transluminal angioplasty (PTA).
- MMD patients with ostial lesions showed poorer PTA outcomes; combined treatment is suggested, as angioplasty alone was insufficient.
Conclusions:
- Moyamoya disease is the leading cause of RVH in Korean children.
- RVH associated with MMD and ostial lesions has suboptimal outcomes with PTA alone.
- Combined therapeutic strategies are essential for managing RVH in MMD patients to prevent target-organ damage.
Background:
Renovascular hypertension (RVH) accounts for 5-10% of pediatric hypertension, and can be associated with underlying disease involving other organs. The purpose of this study was to evaluate the clinical characteristics and assess the treatment outcomes of Korean pediatric patients with RVH.
Methods:
The medical records of 25 Korean pediatric patients with RVH were retrospectively reviewed.
Results:
Twenty-four patients had underlying disease, and the most common cause was moyamoya disease (MMD; n = 10; 40%). Of 10 patients with MMD, seven had RVH prior to MMD. All patients required antihypertensive medication as the initial treatment and 22 patients subsequently underwent percutaneous transluminal angioplasty (PTA). The majority of patients with MMD had ostial lesions on angiography. Eight patients had favorable outcomes after the first PTA. One patient received nephrectomy, and two patients received bypass surgery because of restenosis after PTA and technical failure of PTA, respectively. During follow up, blood pressure was well-controlled in nine patients, but only four patients were able to discontinue medication. Eight patients had target-organ damage of the brain, heart, and retina at the time of initial diagnosis, and five patients developed chronic kidney disease during follow up.
Conclusion:
The most common cause of RVH in Korean children is MMD, and RVH caused by MMD with an ostial lesion is associated with poor PTA outcomes. Angioplasty alone does not appear to control blood pressure effectively in MMD patients, and combined treatment is necessary to prevent target organ damage.
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