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Renal artery stenosis in infants: long-term medical treatment before surgery
M Bendel-Stenzel1, J S Najarian, A R Sinaiko
1Department of Pediatrics, University of Minnesota Medical School, Minneapolis 55455, USA.
Insights
Infants with renal artery stenosis can be successfully treated with long-term antihypertensive drugs to preserve kidney function. This approach leads to minimal long-term adverse effects and normal blood pressure post-surgery.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Vascular Surgery
Background:
- Renal artery stenosis (RAS) in infants presents a significant challenge, often leading to severe complications like congestive heart failure.
- Early diagnosis and management are crucial for improving outcomes in affected infants.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of antihypertensive drug therapy in infants diagnosed with renal artery stenosis.
- To assess the impact of this management strategy on preserving renal mass and overall cardiovascular health.
Main Methods:
- Retrospective analysis of five infants diagnosed with renal artery stenosis within their first year of life.
- Inclusion of diagnostic data (renograms, intravenous pyelograms, renal ultrasounds) and treatment details (antihypertensive therapy duration, surgical correction).
- Long-term follow-up assessing blood pressure control and clinical outcomes post-intervention.
Main Results:
- All five infants presented with congestive heart failure, cardiomegaly, and left ventricular hypertrophy.
- Four out of five infants had abnormal renograms; two out of three had abnormal intravenous pyelograms.
- Antihypertensive therapy was administered for an average of 4.4 years prior to surgical correction, with persistent hypertension in four infants.
- Post-surgery follow-up (average 9.4 years) showed normal blood pressure in four patients; one patient had borderline hypertension.
Conclusions:
- Infants with renal artery stenosis can be managed successfully with prolonged antihypertensive drug therapy to preserve renal mass.
- This therapeutic approach demonstrates minimal chronic adverse effects and leads to favorable long-term blood pressure control after surgical correction.
- Early intervention and sustained medical management are key to positive outcomes in pediatric renal artery stenosis.
Abstract:
This report describes five infants (3 male, 2 female) with renal artery stenosis diagnosed in their 1st year of life. The age at initial presentation was 5 days to 10 months. All had symptoms of congestive heart failure, cardiomegaly on chest X-ray, and left ventricular hypertrophy by electrocardiogram or echocardiogram. Renograms were abnormal in four of the five infants. An intravenous pyelogram was obtained in three infants and was abnormal in two. Renal ultrasounds were obtained in two infants and were normal in both. Patients were treated for 4.4 +/- 0.9 years with antihypertensive drug therapy until surgical correction of the renal artery stenosis. Blood pressure was persistently elevated above the 95th percentile in four of the infants during the course of antihypertensive therapy prior to surgery. Patients have been followed for 9.4 +/- 2 years since surgery. The blood pressure of four patients is normal, and the blood pressure of the oldest patient (age 23 years) is borderline hypertensive. These data show that infants with renal artery stenosis can be cared for successfully with long-term antihypertensive drug therapy to preserve renal mass with minimal chronic adverse effects.