The diagnosis of renovascular disease

Dillon, Michael J.

doi:10.1007/s004670050300

Cited by 72 publications

(62 citation statements)

References 66 publications

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“…It has been considered as a promising, simple, non-invasive method in pediatrics [1]. However, although the idea is very elegant, in practice the results have been inconsistent [12].…”

Section: Captopril-enhanced Renal Scintigraphymentioning

confidence: 99%

“…Not much more than one decade ago the diagnostic workup of pediatric hypertension seemed to be a solid field with rapidly evolving non-invasive diagnostic procedures that promised to eliminate the need for the more invasive classical diagnostic tests [1]. The emergence of the new epidemic of pediatric hypertension from obesity becoming the third most common chronic disease in the industrialized world, the monochromic picture has been somewhat blurred [2].…”

Section: Introductionmentioning

confidence: 99%

“…The emergence of the new epidemic of pediatric hypertension from obesity becoming the third most common chronic disease in the industrialized world, the monochromic picture has been somewhat blurred [2]. The prevalence of childhood obesity has more than tripled over the past 30 years, and it now approaches or exceeds 20% in some pediatric age groups [1,3,4]. Obese children are more likely to have elevated systolic or diastolic blood pressure (BP) than non-obese children, and body mass index (BMI) is a significant predictor of elevated BP.…”

Section: Introductionmentioning

confidence: 99%

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Captopril-enhanced renal scintigraphy in the diagnosis of pediatric hypertension

et al. 2010

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Hypertension in childhood is no longer a rare condition mainly secondary to renal, or renovascular diseases, as a growing proportion of children are obese and hypertensive, with the phenotype of metabolic syndrome. Thus, we need to reconsider our practice in the examination of the hypertensive child and redefine the place of non-invasive methods for screening of renovascular hypertension, and specifically, to evaluate the value of captopril-enhanced renal scintigraphy at the two ends of the palette: the obese child with hypertension and the severely hypertensive prepubertal child. Renal artery stenosis in children is mainly due to fibromuscular dysplasia and stenoses associated with syndromes involving single or multiple smaller branch vessels. This explains the low specificity and sensitivity of the color-Doppler ultrasound method and captopril renal scintigraphy. Even the more sophisticated computed tomography (CT) and magnetic resonance imaging (MRI) angiographic techniques are, at present, not sensitive enough to exclude stenoses of the small branches definitely. Thus, children in whom there is a strong suggestion of renovascular hypertension should undergo angiography with a view to endovascular treatment, as non-invasive imaging has no significant benefit and might lead to a delay in treatment. In the cases when the probability of renovascular disease is moderate a basic assessment of renal function and structure is sufficient. In the neonate, catheter-associated thromboembolic disease is among the most common causes hypertension. It should be controlled medically until the patient is old enough to undergo angiography and angioplasty successfully. Thus, in this age group, there is a place for functional imaging with renal sonography and angiotensin-converting enzyme inhibitor (ACEI) renography to detect hemodynamically significant renovascular disease, with the limitations mentioned above. However, the rapid technical evolution of non-invasive methods requires periodic re-consideration of the actual standpoints.

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“…It has been considered as a promising, simple, non-invasive method in pediatrics [1]. However, although the idea is very elegant, in practice the results have been inconsistent [12].…”

Section: Captopril-enhanced Renal Scintigraphymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Captopril-enhanced renal scintigraphy in the diagnosis of pediatric hypertension

et al. 2010

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“…Renal artery stenosis (RAS) is an unusual cause of hypertension in children and most paediatric nephrologists will only see a very limited number of cases during their active professional life [1]. It is, however, very important to diagnose and treat RAS correctly as it is potentially curable with angioplasty and/or surgery.…”

Section: Introductionmentioning

confidence: 99%

Renal artery stenosis: is angiography still the gold standard in 2011?

Tullus

2011

Pediatr Nephrol

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Renovascular hypertension (RVH) is an unusual cause of hypertension in children that is important to diagnose as it is potentially curable with angioplasty or surgery. Digital subtraction angiography is the gold standard for diagnosing RVH; for other methods like ultrasound, isotope studies, magnetic resonance angiography and computed tomography angiography sensitivity is still too low to reliably exclude RVH. Clinical and laboratory criteria that suggest RVH will be proposed and recommendations when digital subtraction angiography should be performed will be made. A treatment algorithm that suggests when to use medical treatment, interventional radiology and surgery in children with RVH will be given.

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“…43,44 Affected children usually, but not invariably, have markedly elevated BP. 40,44 Evaluation for renovascular disease also should be considered in infants or children with other known predisposing factors, such as prior umbilical artery catheter placements or neurofibromatosis.…”

Section: E V a L U A T I O N F O R P O S S I B L E R E N O V A S C U mentioning

confidence: 99%

Hypertension

DFTB¹

2013

DFTB

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The diagnosis of renovascular disease

Cited by 72 publications

References 66 publications

Captopril-enhanced renal scintigraphy in the diagnosis of pediatric hypertension

Captopril-enhanced renal scintigraphy in the diagnosis of pediatric hypertension

Renal artery stenosis: is angiography still the gold standard in 2011?

Hypertension

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