RENAL-ARTERY STENOSIS IN AORTOARTERITIS - SPECTRUM OF DISEASE IN CHILDREN AND ADULTS

Nonspecific aortoarteritis is the commonest cause of renovascular hype rtension (RVH) accounting for 87% of the patients in the present study . We compared the clinical and radiographic features and outcome in ch ildren (n = 16) and adult (n = 24) patients with aortoarteritis. Child ren have a shorter duration of disease and present more commonly with constitutional symptoms. All the patients were hypertensive; however, malignant hypertension and hypertensive encephalopathy were more commo n in children. Abdominal bruit and asymmetry of pulses were present on ly in 75 and 35% of the patients, respectively. Asymmetric kidney size on ultrasound was present in 15 of 24 adults, whereas 9 of 16 childre n had equal sized kidneys. Captopril renography had a better sensitivi ty for detection of RVH in children (13 of 16 in children vs. 12 of 24 in adults showing positive results). On intra-arterial digital substr action angiography, abdominal aortic involvement was invariable, where as the thoracic aorta was involved less frequently in both age groups. Angiographic scores for the severity of vascular involvement was sign ificantly lesser in children (6.87 +/- 4.8) as compared to adults (11. 32 +/- 4.5). Thirteen of the 15 children were found suitable for revas cularization, whereas 12 of 24 adults were not considered for revascul arization as their kidneys were small and contributed to less than 10% of total function. Six of the adult patients underwent nephrectomy fo r the control of blood pressure. Results of angioplasty were also bett er in children than adults. We conclude that children present earlier with less severe vascular disease and respond better to revascularizat ion, as compared to adults.