Segmental kidney resection in children with small, hypertension-producing intrarenal vascular lesions

Renal angiography is indispensable in the study of children with suspected renal hypertension. Main or segmental renal artery stenoses are usually well-demonstrated by midstream abdominal aortography, but small intrarenal vascular abnormalities can be easily overlooked when such a nonselective method is used. Such tiny abnormalities, however, can be the cause for, or indication of focally increased renin production and consequent hypertension. The most common primary intrarenal lesions (stenoses, focal occlusions) may be readily apparent on good arteriograms. Quite often, however, they are angiographically occult, and their presence is indicated indirectly by tortuous or "corkscrew" intrarenal collaterals. The need for selective renal arteriograms and segmental renal vein renin assays in the work-up of such patients is stressed, and the effectiveness of treatment by segmental renal resection rather than nephrectomy in patients with such lesions is illustrated.