HYPERTENSION IN PEDIATRICS - CAN PRE-CAPTOPRIL AND POST-CAPTOPRIL TC-99M DIMERCAPTOSUCCINIC ACID RENAL SCANS EXCLUDE RENOVASCULAR DISEASE

In children over 1 year of age, renal disease is the commonest cause o f hypertension. Arteriography is considered the reference method to es tablish the diagnosis of renovascular disease; however, it is an invas ive technique with a high radiation burden for children. This was a re trospective study of pre- and post-capto-technetium-99m dimercaptosucc inic acid (DMSA) imaging compared with arteriography in 18 children be tween the ages of 3 and 17 years. Alone, the Tc-99m-DMSA scan is a sen sitive indicator of renal parenchymal disease, although non-specific i n suggesting the pathology. The combination of pre- and post-captopril studies may increase the sensitivity and specificity in the diagnosis of renovascular disease in the presence of hypertension. This work su ggests that a screening investigation with a low radiation burden can be carried out at most institutions; if the investigation is positive, there will be a high index of suspicion that renovascular disease is the cause of the hypertension.