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Renovascular hypertension

J A O'Neill1

  • 1Department of Surgery, Children's Hospital of Philadelphia, PA 19104.

Seminars in Pediatric Surgery
|May 1, 1994
PubMed
Summary
This summary is machine-generated.

Pediatric hypertension, especially in young children, often has surgically correctable causes like renovascular issues. Surgical interventions, such as bypass or angioplasty, can cure or significantly improve hypertension in over 90% of cases.

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Area of Science:

  • Pediatric Nephrology
  • Vascular Surgery
  • Pediatric Hypertension

Background:

  • Hypertension affects 1-5% of children, with a higher incidence of surgically correctable causes in those under 5 years old (78%).
  • Etiologies are diverse, including endocrine, neurological, metabolic, renal, infectious, and vascular disorders, with renovascular causes being most common.

Purpose of the Study:

  • To review the diagnostic and therapeutic approaches for pediatric renovascular hypertension.
  • To highlight the importance of early diagnosis and surgical correction for improved outcomes.

Main Methods:

  • Diagnostic workup includes serum urea and electrolytes, sedimentation rate, and 24-hour urine analysis for various substances.
  • Advanced imaging like aortography with bilateral renal arteriography and renal vein renin levels are crucial.

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  • Surgical options discussed include transluminal balloon angioplasty, aortorenal bypass, and nephrectomy.

    • Main Results:

    • Transluminal balloon angioplasty is effective for branch renal artery stenosis but less so for proximal stenosis.
    • Aortorenal bypass or direct reimplantation are preferred for proximal renal artery stenosis.
    • Surgical revascularization leads to cure or significant improvement in over 90% of patients with minimal mortality.

    Conclusions:

    • Renovascular hypertension in children, particularly young ones, requires prompt diagnosis and intervention.
    • Surgical management, tailored to the specific stenosis location, offers excellent outcomes.
    • Avoiding total nephrectomy preserves renal function and is preferred when possible.