ACE inhibition scintigraphy in the management of hypertension in children

Angiotensin converting enzyme (ACE) inhibition scintirenography was perform ed to help establish the diagnosis and plan treatment of renovascular hyper tension (RVH) in 57 hypertensive pediatric patients, 33 infants and 24 chil dren older than 1 year. In 16 of 33 hypertensive infants, ACE inhibition sc intirenography established the diagnosis of RVH from renal ischemia (due to aortic or renal arterial thrombi). Two scintigraphic criteria were used fo r the diagnosis of RVH: criterion I, ischemic and damaged kidney (a non-fun ctioning kidney on or off ACE inhibition) and criterion II, ischemic but no t damaged kidney (ACE inhibition induced deterioration of function of the k idney). When criterion I was present and the contralateral kidney was norma l, ACE inhibitors could be used for treatment of hypertension without deter ioration of renal function; kidneys satisfying criterion I eventually invol uted or manifested growth arrest and frequently caused persistent RVH, even after resolution of the thrombus, requiring nephrectomy. When criterion II was present bilaterally, or it was associated with criterion I contralater ally, the use of antihypertensive drugs other than ACE inhibitors was neces sary in order to prevent renal insufficiency or failure from ACE inhibitors . However, kidneys with criterion II showed normal growth and, following re traction or dissolution of the aortic thrombus, hypertension resolved. In 2 of 24 hypertensive children older than 1 year, the test was diagnostic of branch renal artery stenosis; RVH was cured by selective angioplasty. ACE i nhibition scintirenography is useful in the evaluation and planning of trea tment in children with hypertension and may predict the outcome of therapy and ultimate renal function.