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The radiological evaluation of children with hypertension
Insights
Radiological exams are crucial for diagnosing pediatric hypertension. Renal angiography is essential for identifying treatable causes of hypertension in children, guiding surgical interventions.
Area of Science:
- Pediatric Nephrology
- Diagnostic Radiology
Background:
- Hypertension in children requires thorough investigation to identify secondary causes.
- Early diagnosis and treatment of secondary hypertension can prevent long-term complications.
Purpose of the Study:
- To evaluate the diagnostic value of various radiological examinations in children with hypertension.
- To determine the necessity of renal angiography in the workup of pediatric hypertension.
Main Methods:
- Retrospective analysis of 44 children diagnosed with hypertension.
- Review of intravenous urography, renal angiography, and micturating urethrocystography findings.
- Assessment of complication rates associated with radiological procedures.
Main Results:
- Intravenous urography revealed abnormalities in 44% of cases.
- Renal angiography identified significant findings in 63% of pediatric patients.
- One case of renal artery stenosis was detected via renal angiography in a child with hydronephrosis.
Conclusions:
- Renal angiography provides critical information for diagnosing secondary hypertension in children.
- Extensive radiological investigation, including renal angiography, is mandatory for accurate diagnosis and treatment planning.
- Identifying surgically treatable causes of hypertension is essential before initiating long-term management.
Abstract:
The value of radiological examinations in hypertension was analyzed in a series of 44 children. An i.v. urography had been performed in 43 cases with a pathological finding in 19 (44%). Renal angiography, employed in 19 cases, revealed abnormal findings in 12 (63%) patients. Micturating urethrocystography performed in 16 children gave no additional important information. The only complication noted was thrombosis of the femoral artery subsequent to renal angiography in one child less than one year of age. The diagnosis of hypertension based mainly on the i.v. urography in 12 cases but the renal angiography gave additional important information in 6 children. One child with obstructive hydronephrosis was also found to have a renal artery stenosis at renal arteriography. Based on these results, and particularly because secondary hypertension may frequently be treated surgically, we consider extensive radiological investigation with renal angiography is mandatory before receiving a final diagnosis of essential hypertension, and before starting long-term treatment.