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Transient renal artery stenosis in infants: myth or reality?
P Robitaille1, L Garel, J Duois
1Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Canada.
Insights
Severe hypertension in infants due to bilateral renal artery stenoses can resolve spontaneously. Medical management proved effective, leading to medication discontinuation and resolution of stenoses, highlighting its value over risky procedures.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Medicine
- Medical Imaging
Background:
- Infants presenting with severe hypertension often require aggressive management.
- Bilateral renal artery stenoses are a critical cause of pediatric hypertension.
- Interventional procedures carry significant risks in neonates.
Observation:
- Two infants with bilateral renal artery stenoses and severe hypertension were managed medically.
- Antihypertensive medication requirements decreased over time.
- Blood pressure normalized, and medication was discontinued in both cases.
Findings:
- Repeat arteriograms showed near-complete resolution of bilateral renal artery stenoses.
- Medical management alone led to sustained normotension.
- The transient nature of the stenoses and hypertension was observed.
Implications:
- Conservative medical management is a viable and potentially curative option for infant hypertension secondary to renal artery stenoses.
- This approach may obviate the need for invasive procedures like balloon angioplasty in select pediatric cases.
- Understanding the potential for spontaneous resolution is crucial for optimizing treatment strategies in pediatric renovascular hypertension.
Abstract:
We describe two infants with bilateral renal artery stenoses and severe hypertension. Adequate control of blood pressure was achieved by medical management. Endoluminal balloon dilatation of the renal arteries had been deferred because of their small size. On follow-up it was noticed that blood pressure had become progressively easier to control, with lesser amounts of antihypertensive medication. In fact, medication could be completely discontinued and blood pressure remained normal. On repeat arteriogram, bilateral renal artery stenoses had almost resolved in both patients. The etiology of the stenoses was not established in these patients. However, regardless of etiology, the transient nature of hypertension and renal artery stenoses in these two cases demonstrates that patient medical management of hypertension in infants can be a valid therapeutic option and occasionally obviate the need for unnecessary risky procedures.