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Renovascular hypertension in childhood: a changing perspective in management
Insights
Renovascular hypertension in children caused by renal artery lesions is treatable. Most patients achieved normal blood pressure after surgical or interventional procedures, preserving kidney function.
Area of Science:
- Pediatric Nephrology
- Vascular Surgery
- Interventional Cardiology
Background:
- Renovascular hypertension in children is often caused by intrinsic renal artery lesions.
- Symptoms at presentation can range from asymptomatic to severe, including headaches, epistaxis, anorexia, and failure to thrive.
- Diagnostic imaging like intravenous pyelogram and radionuclide renal scan show abnormalities in a significant percentage of patients.
Purpose of the Study:
- To evaluate treatment outcomes for pediatric renovascular hypertension caused by intrinsic renal artery lesions.
- To assess the efficacy of various surgical and interventional procedures.
- To emphasize individualized therapy for renal parenchyma preservation.
Main Methods:
- Retrospective analysis of 17 children treated over 10 years.
- Diagnostic workup including arteriography and renal vein renin ratio measurements.
- Treatment modalities included partial nephrectomy, nephrectomy, autotransplantation, and angioplasty.
Main Results:
- Arteriography identified branch artery stenosis in 7 patients and main artery lesions in 10.
- Renal vein renin ratio >= 1.5 was observed in 10 of 17 patients.
- 15 of 16 follow-up patients were normotensive after a mean of 3.7 years.
- Successful treatments included nephrectomy (n=5), partial nephrectomy (n=2), autotransplantation (n=6), and angioplasty (n=2).
Conclusions:
- Pediatric renovascular hypertension due to intrinsic renal artery lesions can be effectively treated.
- Surgical and interventional therapies, individualized to each patient, lead to high rates of normotension and renal preservation.
- Transluminal balloon angioplasty showed limited success, particularly for branch artery stenoses.
Abstract:
Seventeen children with renovascular hypertension caused by intrinsic renal artery lesions received treatment during the past 10 years. At presentation nine were asymptomatic, four had headaches, and one had epistaxis; three infants had anorexia and failure to thrive. Routine intravenous pyelogram and radionuclide renal scan findings were abnormal in 29% and 31% of patients, respectively. Arteriography showed a branch artery stenosis in seven patients and a main artery lesion in 10. A renal vein renin ratio of greater than or equal to 1.5 between the affected and the contralateral kidney was obtained in 10 of 17 patients. Of 16 patients available for follow-up, 15 are normotensive after a mean follow-up of 3.7 years. Cure was achieved by partial nephrectomy and ligation of a stenosed vessel in two and nephrectomy in five (three having undergone an unsuccessful angioplasty procedure). Autotransplantation or angioplasty was curative in a further six. Transluminal balloon angioplasty was attempted in seven patients but was successful in only two with main renal artery stenoses. With preservation of renal parenchyma as the main goal, medical and surgical therapy can be individualized for each patient.