Value of Doppler ultrasound for the diagnosis of renal artery stenosis in children

Brun, P; Kchouk, H.; Mouchet, B.; Baudouin, Véronique; Raynaud, A.; Loirat, Chantal; Azancot-Benisty, A.

doi:10.1007/s004670050227

Cited by 62 publications

(15 citation statements)

References 22 publications

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“…This is consistent with the fact that, despite a reported sensitivity of 84%-100% for renal artery stenosis [10,22,28,29], this technique can diagnose stenotic lesions only when they are sufficient to cause hypertension [10,30]. Doppler ultrasonography may be helpful in diagnosing the underlying presence of vascular abnormalities in patients with overt hypertension [10].…”

Section: Discussionsupporting

confidence: 81%

Renovascular disease and hypertension in children with neurofibromatosis

Fossali

Signorini

Intermite

et al. 2000

Pediatric Nephrology

116

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Neurofibromatosis type 1 (NF1) is associated with vascular lesions, such as renal artery stenosis, and secondary hypertension. The real prevalence is largely unknown, particularly in children. We observed 27 patients with NF1, mean age 12.8 years (range 4.2-24 years), for 2-10 years to assess the association of NF1 with vascular abnormalities and secondary hypertension. Patients were studied with angiography, 24-h blood pressure monitoring, a captopril test, and Doppler ultrasonography of aorta and renal arteries. The prevalence of hypertension was 18.5%; 61.5% of patients studied with angiography had vascular lesions, half of whom were apparently normotensive. However, they had abnormal 24-h blood pressure monitoring, which was a first sign of poor blood pressure control. Those patients with severe hypertension (11.1%) were successfully treated with percutaneous transluminal angioplasty (PTA); stenosis recurred in 2 of 3 patients after a 2-year follow-up period, and was responsive to drugs. We conclude that hypertension is a frequent complication of NF1 in pediatric patients, it is usually secondary to typical vascular lesions, and requires careful follow-up. Ambulatory blood pressure monitoring (24-h) is a sensitive method for detecting initial alterations of the blood pressure pattern. PTA may be an effective treatment in this condition.

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Section: Discussionsupporting

confidence: 81%

Renovascular disease and hypertension in children with neurofibromatosis

Fossali

Signorini

Intermite

et al. 2000

Pediatric Nephrology

116

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“…An abdominal bruit is heard in only about 40% of these patients. Color Doppler renal artery sonography is able to detect stenoses of the renal artery, but it is strongly dependent on the operator's experience [46]. It is usually the first diagnostic modality because it is non-invasive and not expensive.…”

Section: Etiological Classification Of Elevated Bpmentioning

confidence: 99%

“…A simple analysis of blood and urinary electrolytes provides a good interpretation of the reninaldosterone axis and may suggest an endocrine or monogenic form of inherited hypertension. According to the history, clinical signs and symptoms and basic laboratory investigations, other investigations may be indicated: glomerular filtration rate/creatinine clearance, Doppler ultrasound of the renal arteries [44,45,46], renal isotope studies with dimercaptosuccinic acid (DMSA) or mercaptoacetyltriglycine (MAG 3) before and after ACE inhibitor priming [44,51,52], 24-h urinary steroid profile and vanillylmandelic acid [61].…”

Section: Basic Investigations In the Child With Hypertensionmentioning

confidence: 99%

A diagnostic approach for the child with hypertension

Varda

Gregorič

2005

Pediatr Nephrol

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Hypertension during childhood is not rare, with an estimated prevalence of between 1% and 2%, although it is often an underrecognized clinical entity. Elevated blood pressure may be a sign of underlying disease or it may represent early onset of essential hypertension. In recent years the measurement of blood pressure has been emphasized as an important component of the routine pediatric physical examination that enables early detection of children with hypertension. In the evaluation of the child with documented blood pressure elevation, confirmation of truly and persistently elevated blood pressure is of the utmost importance. In addition, a thorough history and a full clinical examination are essential. These are followed by appropriate investigations, which are tailored to the age of the child and to the severity of the blood pressure elevation. Investigations should not only focus on a search for the underlying cause, but also on establishing effects on target organs, complications or additional diseases and on assessment of the total cardiovascular risk to the individual patient. An algorithm, which is a valuable diagnostic tool for the diagnosis and management of the child with hypertension, is presented. All children with confirmed hypertension need long-term follow-up, counseling and treatment. In those cases where an underlying cause of the hypertension is detected, the established diagnosis then determines the specific therapy and management.

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“…Most children undergo abdominal US and echocardiography for this purpose [19]. It is possible to detect some but not all stenosis of a main renal artery using various US parameters, but the sensitivity is not adequate for detection of intrarenal lesions [20][21][22]. For this reason, some authors recommend a sequential increase in imaging intensity, from US through CT and MR imaging with MR angiography (MRA) to digital subtraction angiography (DSA) [19].…”

Section: Noninvasive Imagingmentioning

confidence: 99%