Imaging of Renin-Mediated Hypertension in Children

Castelli, Patricia; Dillman, Jonathan R.; Smith, Ethan A.; Vellody, Ranjith; Cho, Kyung; Stanley, James C.

doi:10.2214/ajr.12.9427

Cited by 17 publications

(13 citation statements)

References 20 publications

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“…As characteristically small lesions at presentation (≤10 mm), reninomas are easily overlooked at imaging – imaging typically directed at identifying a vascular cause for renin-mediated hypertension (17). …”

Section: Discussionmentioning

confidence: 99%

Reninoma: An Uncommon Cause of Renin-Mediated Hypertension

et al. 2014

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Reninoma (juxtaglomerular cell tumor) is a rare cause of renin-mediated hypertension. Reninomas are usually diagnosed in adolescents and young adults with occasional reports in younger children. Patients typically present with a long history of headaches leading to a diagnosis of severe hypertension that responds well to antihypertensive treatment targeting the renin-angiotensin-aldosterone system. The clue to clinical diagnosis is the presence of hypokalemia and metabolic alkalosis on the first blood sample drawn before any treatment is instituted. Elevated blood levels of renin and aldosterone confirm the clinical suspicion of renin-mediated hypertension. Diagnostic imaging is employed to identify the source of excessive renin production. While renal ultrasound can miss reninoma, contrast CT or magnetic resonance imaging of the kidneys are diagnostic modalities of choice leading to the correct diagnosis. Renal vein renin sampling with lateralization might help to identify the site of excessive renin production. Nephron-sparing surgery is curative with maintenance of normal blood pressure after discontinuation of antihypertensive medications in the majority of patients. In this paper, we present the case of reninoma in an adolescent girl emphasizing clinical presentation, diagnostic evaluation, and medical and surgical treatment of this rare tumor. We also discuss important points in the management of children presenting with renin-mediated hypertension.

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Section: Discussionmentioning

confidence: 99%

Reninoma: An Uncommon Cause of Renin-Mediated Hypertension

et al. 2014

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“…Both PRA and renal Doppler US are often used as the initial screening tests in children with hypertension . Plasma renin activity should be interpreted by using an appropriate pediatric reference range and would be a surrogate for activation of the renin‐angiotensin‐aldosterone system .…”

Section: Discussionmentioning

confidence: 99%

“…The causes of hypertension in pediatric patients are known to differ from those in adult patients, in whom hypertension is usually related to atherosclerosis . Secondary causes of hypertension, such as renal parenchymal disease, are more common in childhood.…”

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confidence: 99%

“…Secondary causes of hypertension, such as renal parenchymal disease, are more common in childhood. Furthermore, it has been reported that hypertension is renin mediated in approximately 5% to 10% of pediatric patients . Therefore, identifying the presence of renin‐mediated renovascular hypertension (RVHT) is crucial because a radiologic intervention or surgical approach may relieve the associated complications …”

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confidence: 99%

“…Renovascular hypertension can be screened for by plasma renin activity (PRA) and renal Doppler ultrasound (US) but should be confirmed by computed tomographic angiography (CTA). Decreased renal blood flow and perfusion can lead to elevated PRA, activation of the renin‐angiotensin‐aldosterone system, and high blood pressure . However, there are reports of PRA in the normal range in 20% to 37% of patients with RVHT .…”

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confidence: 99%

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Diagnostic Role of Renal Doppler Ultrasound and Plasma Renin Activity as Screening Tools for Renovascular Hypertension in Children

Lee

Choi

Cho

et al. 2019

J of Ultrasound Medicine

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Objectives-The diagnostic role of an ultrasound (US) and plasma renin activity (PRA) combination is unknown, despite the usefulness of Doppler US as a screening tool for renovascular hypertension (RVHT). The purpose of this study was to evaluate the diagnostic usefulness of US for RVHT in children stratified according to PRA.Methods-We identified 336 children who underwent renal Doppler US examinations for hypertension and divided them into a high-renin group (n = 177) and a normal-renin group (n = 159) based on PRA and stratified them by age. The Doppler US findings were retrospectively reviewed, and computed tomographic angiography (CTA) for the same children was used as the reference standard.Results-In the high-renin group, 36 patients had positive Doppler US findings that were confirmed by CTA in 32 cases. The sensitivity and specificity values for Doppler US in the high-renin group were 84.2% and 93.6%, respectively. In the normal-renin group, 10 patients had positive Doppler US findings; these positive findings were confirmed by CTA in 9 cases. The sensitivity and specificity values for US in the normal-renin group were 100.0% and 100.0%. There were anatomic variations (n = 3) and segmental artery stenosis (n = 2) among the cases with false-negative US findings, which were confirmed by CTA.Conclusions-If patients have high PRA, a Doppler US examination should be performed with caution to avoid false-negative detection. If patients have normal PRA, renal Doppler US might be adequate for diagnosis of RVHT to avoid unnecessary CTA.

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