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Pediatric Renovascular Hypertension: Manifestations and Management

Leonela Villegas1, Anne Marie Cahill2, Kevin Meyers3

  • 1Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. Correspondence to: Dr Leonela Villegas, Department of Nephrology, Buerger Building, 9th floor, 3500 Civic Center Blvd, Philadelphia, PA 19104, USA. villegasl@email.chop.edu.

Indian Pediatrics
|March 30, 2020
PubMed

Insights

Renovascular hypertension (RVHTN) in children, caused by renal artery stenosis (RAS), often presents as silent hypertension. Early diagnosis and a multidisciplinary approach are crucial for managing this secondary cause of high blood pressure.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Medicine
  • Hypertension Research

Background:

  • Renovascular hypertension (RVHTN) is a significant cause of secondary hypertension in children.
  • Delayed diagnosis of renal artery stenosis (RAS) can lead to adverse health outcomes.
  • Etiologies of RAS are diverse, including anatomical, inflammatory, and genetic factors.

Purpose of the Study:

  • To highlight the importance of early diagnosis of RVHTN in pediatric patients.
  • To discuss the varied etiologies and clinical manifestations of RAS.
  • To outline diagnostic and management strategies for pediatric RVHTN.

Main Methods:

  • Review of clinical presentation, diagnostic workup, and management of pediatric RVHTN.
  • Discussion of imaging modalities including ultrasound, CT angiography, MR angiography, and scintigraphy.
  • Emphasis on angiography as the gold standard for RAS diagnosis.

Main Results:

  • RVHTN often presents as isolated hypertension with potential electrolyte derangements or renal dysfunction.
  • A high index of clinical suspicion is necessary for diagnosis.
  • Angiography remains the gold standard for diagnosing renal artery stenosis.

Conclusions:

  • Prompt diagnosis and management of pediatric RVHTN are essential to prevent complications.
  • A comprehensive, multidisciplinary team approach is vital for optimal patient care.
  • Treatment strategies involve antihypertensive therapy, potentially combined with radiological or surgical interventions.

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