Reno-vascular hypertension in childhood: a nationwide survey

Abstract

Renovascular disease accounts for 8-10% of all cases of paediatric hypertension, whereas, in adults, its incidence is approximately 1%. The Turkish Paediatric Hypertension Group aimed to create the first registry database for childhood renovascular hypertension in Turkey. Twenty of the 28 paediatric nephrology centres in Turkey responded to the survey and reported 45 patients (27 girls, 18 boys) with renovascular hypertension between 1990 and 2005. The age at presentation ranged from 20 days to 17 years. The mean blood pressure at the diagnosis was 169/110 mmHg. Chief complaints of symptomatic patients were headache (38%), seizure (18%), epistaxis (4%), growth retardation (4%), cognitive dysfunction (4%), polyuria (2%), palpitation (2%), and hemiplegia (2%). Renovascular hypertension was found incidentally in 11 children. The diagnosis of renovascular hypertension was established with conventional angiography in 39 patients, MR angiography in three, CT angiography in two, and captopril diethylene triamine penta-acetic acid (DTPA) scintigraphy in one patient. Twenty-one children had bilateral renal artery stenosis and 24 had unilateral renal artery stenosis. Of these, 14 (31%) had fibromuscular dysplasia; 12 (27%) Takayasu's arteritis; six (13%) neurofibromatosis; two (5%) Williams syndrome; one (2%) Kawasaki disease; one (2%) mid-aortic syndrome; one (2%) extrinsic compression to the renal artery, and eight (18%) unspecified bilateral renal artery stenosis. Hypertension was controlled with antihypertensive drugs in 17 patients. Percutaneous transluminal angioplasty (PTRA) or surgery had to be performed in 28 patients: PTRA in 16 patients, PTRA + surgery in one patient and surgery in 11 patients (four nephrectomies). The importance of vasculitic disease, especially Takayasu's arteritis, should not be underestimated in children with renovascular hypertension.

Renal Transplantation for Fibromuscular Dysplasia

“…In pediatrics, FMD is reported to be the most important cause of renovascular hypertension, but the prevalence is not precisely known. In a cohort of Turkish children with renovascular hypertension, FMD was found in 31% (5).…”

Renovascular hypertension: a case with atypical neurological signs

“…Early diagnosis is essential because adequate treatment can prevent target organ damage 3 5. In the case described, RVH diagnosis was late and difficult because of its presentation with FTT, slowing of linear growth and atypical neurological signs.…”

Posterior reversible encephalopathy syndrome in a child with unilateral renal artery stenosis with hypertensive emergency

“…Hence a stepwise reduction should be planned. Hypertensive emergencies should be treated by an IV antihypertensive that can produce a controlled reduction in the BP, aiming to decrease the pressure by 25% over the first 8 hours after presentation and then gradually normalizing the BP over the next 48 hours 7 . IV labetalol and sodium nitroprusside are the preferred agents.…”