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A simple, refined approach to diagnosing renovascular hypertension in children: A 10-year study

Ken Saida1, Koichi Kamei1, Riku Hamada2

  • 1Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|March 11, 2020
PubMed

Insights

Non-invasive tests like kidney ultrasound and plasma renin activity (PRA) show high sensitivity for diagnosing renovascular hypertension (RVH) in children. Computed tomography angiography (CTA) offers 100% sensitivity and specificity, enabling diagnosis without invasive catheter angiography.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Imaging
  • Hypertension Diagnostics

Background:

  • Catheter angiography is the gold standard for diagnosing renovascular hypertension (RVH), but its utility is limited.
  • Non-invasive imaging and blood tests for RVH lack sufficient evidence for widespread clinical use.

Purpose of the Study:

  • To evaluate the diagnostic utility of non-invasive blood tests and imaging modalities for renovascular hypertension (RVH) in pediatric patients.
  • To compare the accuracy of kidney ultrasonography (US), computed tomography angiography (CTA), plasma renin activity (PRA), and aldosterone levels against catheter angiography in diagnosing RVH.

Main Methods:

  • Retrospective analysis of 10 pediatric patients diagnosed with RVH between 2008 and 2017.
  • Comparison of sensitivities for diagnosing RVH using kidney US, PRA, aldosterone, and CTA against catheter angiography.
  • Calculation of CTA sensitivity and specificity considering both affected and non-affected renal arteries.

Main Results:

  • Kidney ultrasonography (US) demonstrated 89% sensitivity, and plasma renin activity (PRA) showed 80% sensitivity for RVH diagnosis.
  • Computed tomography angiography (CTA) achieved 100% sensitivity and 100% specificity in diagnosing RVH.
  • Renal vein renin (RVR) sampling provided limited diagnostic value; renal scintigraphy identified non-functional kidneys.

Conclusions:

  • Renal artery stenosis (RAS) and renovascular hypertension (RVH) in children can be diagnosed effectively using non-invasive methods.
  • Kidney length measurement and PRA levels serve as a reliable screening tool, with CTA as a subsequent diagnostic test.
Abstract

Keywords:
computed tomographic angiographyfibromuscular dysplasiaplasma renin activityrenal veinrenin samplingrenovascular hypertension

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