Presentation, treatment, and outcome of renovascular hypertension below 2 years of age

Abstract

Renovascular hypertension in most cases requires endovascular treatment and/or surgery. This is technically much more difficult in small children and there is very limited published knowledge in this age group. We here present treatment and outcome of young children with renovascular hypertension at our institution. Children below 2 years of age, with renovascular hypertension between January 1998 and March 2020 were retrospectively reviewed. Demographics and treatment modalities were noted. Primary outcome was blood pressure within a week after the procedures and at last available visit. Sixty-six angiographies were performed in 34 patients. Median age at time of first angiography was 1.03 (interquartile range (IQR) 0.4–1.4) years and systolic blood pressure at presentation 130 (IQR 130–150) mm Hg. Thirty-eight percent (13/34) of children were incidentally diagnosed and 18% (6/34) presented with heart failure. Twenty-six (76%) children had main renal artery stenosis and 17 (50%) mid-aortic syndrome. Seventeen (50%) children showed intrarenal, six (18%) mesenteric, and three (9%) cerebrovascular involvement. Twenty patients underwent 45 percutaneous transluminal angioplasty procedures and seven children surgeries. In 44% of the 16 patients who underwent only percutaneous transluminal angioplasty blood pressure was normalized, 38% had improvement on same or decreased treatment and 19% showed no improvement. Complications were seen in 7.5% (5/66) of angiographies. In four of the seven (57%) children who underwent surgery blood pressure was normalized, two had improved (29%) and one unchanged (14%) blood pressure.Conclusion: In small children with renovascular hypertension below the age of 2 years, percutaneous transluminal angioplasty caused significant improvement in blood pressure with low complication profile. Surgery can be recommended where percutaneous transluminal angioplasty and medical treatments failed. What is Known:• Renovascular hypertension is diagnosed in all age groups from a few weeks of life until adulthood.• Both angioplasty and surgery are significantly more difficult to perform in small children and the published information on short and long-term outcome in these children is very scarce. What is New:• Children below the age of two years can safely and successfully undergo selective renal angiography and also safely be treated with angioplasty.• We here present a large group of babies and infants where angioplasty and in some cases surgery effectively and safely improved their blood pressure.

Cardiovascular outcomes improve in children with renovascular hypertension following endovascular and surgical interventions

“…There is a need for multi-institutional studies to explore the cardiovascular outcomes of intervention compared to medical management alone to investigate the relative efficacy at reducing damage to the cardiovascular system. There are limited studies researching percutaneous transluminal angioplasty in small children with RenoVH [ 9 , 15 , 16 , 20 – 23 ], and thus more research is needed on the outcomes of RenoVH in those under 2 years old.…”

COVID-19 associated renal artery stenosis in infancy - A report of two cases

“…Renal artery stenosis in infancy is extremely rare. [ 3 ] The presentation with fever and elevated biochemical markers indicates an inflammatory etiology. Although these children fulfilled the European League Against Rheumatism/Paediatric Rheumatology International Trials Organization criteria for Takayasu arteritis (fever, hypertension, positive inflammatory markers, and angiographic abnormalities, including subclavian artery involvement), infantile Takayasu arteritis or middle aortic syndrome is rare and is a diagnosis of exclusion.…”