Renovascular hypertension in children

Objective: To study the etiology, clinical spectrum, image findings, manage ment and outcome of children with renovascular hypertension (RVH). Material and methods: Twenty children (aged 5 days to 15 years) were studie d and treated for RVH during 1977-1998. In 14 cases hypertension was found during a routine examination. Six cases had heart failure and/or hypertensi ve encephalopathy. Diagnosis was made with aortography. Postcaptopril renog raphy and Doppler ultrasonography were obtained in 8 patients and spiral co mputed tomography angiography in 2. Treatment consisted of surgery (8 patie nts), percutaneous transluminal angioplasty (PTA) (5) or antihypertensive d rugs only (8). Results: Initial blood pressure was 62 +/- 31 mmHg > 95th percentile for sy stolic and 44 +/- 22 mmHg for diastolic blood pressure. Twelve children had unilateral and 8 had bilateral arterial stenosis. In 3 cases lesions were intrarenal. RVH was due to fibromuscular dysplasia (7 patients) and associa ted to middle aortic syndrome (5), neurofibromatosis (3), William's syndrom e (2), Takayasu's arteritis (1) and pheochromocytoma (1). Treatment of choi ce was decided depending on the size of the child and location and severity of the stenosis. At the end of the follow-up (78 +/- 49 months), 9 patient s are normotensive without medication and 7 are normotensive with drugs. Th ree patients have died, 2 for unrelated causes and 1 for cardiac failure; 1 child was lost to the follow-up. Conclusions: Although symptoms are relatively uncommon, renovascular diseas e is a frequent Cause of severe hypertension in childhood. Non-invasive dia gnostic techniques appear useful as screening methods. Treatment by surgery or PTA is successful if patients are carefully selected.