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The diagnosis of renovascular disease
1Renal Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Insights
Pediatric renovascular disease can cause treatable hypertension. Various diagnostic tools help identify the condition and guide therapy for better outcomes.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Imaging
- Hypertension Research
Background:
- Renovascular disease is a significant, yet treatable, cause of hypertension in children.
- Early diagnosis and intervention are crucial for managing pediatric hypertension secondary to renal artery issues.
Purpose of the Study:
- To review the diagnostic procedures available for investigating renovascular disease in children.
- To highlight the role of these investigations in guiding therapeutic strategies.
Main Methods:
- Review of current diagnostic modalities including Doppler sonography, ACE inhibitor-enhanced imaging, plasma renin activity assays, and angiography (conventional, digital subtraction, CT, MR).
- Discussion of the utility of each method in assessing renal vasculature anatomy and function.
Main Results:
- A comprehensive array of diagnostic tools exists for evaluating pediatric renovascular hypertension.
- These methods allow for detailed assessment of renal artery stenosis and its functional impact.
Conclusions:
- Utilizing the described diagnostic procedures enables precise definition of the renal vasculature's condition.
- This information is essential for selecting the most effective therapeutic interventions for pediatric renovascular hypertension.
Abstract:
Renovascular disease is an important cause of remediable hypertension in childhood. Specific diagnostic procedures currently available to investigate affected children include Doppler and computed duplex sonography, angiotensin converting enzyme (ACE) inhibitor sensitisation of radionuclide imaging, captopril-stimulated plasma renin activity, hypotensive responses to ACE inhibitor, renal vein renin measurements, renal angiography and magnetic resonance angiography. Carbon dioxide digital subtraction angiography and computerised tomographic and spiral angiography are also available and may play an important future role in such evaluations. Utilising this array of procedures it is usually possible to define the anatomical and functional status of the renal vasculature and be guided towards the most appropriate therapeutic manoeuvres.