ACE inhibition scintigraphy in the management of hypertension in children

Chandar, Jayanthi; Sfakianakis, George N.; Zilleruelo, Gastón; Guerra, Jorge J. Llibre; Georgiou, Mike; Abitbol, Carolyn; Montané, Brenda; Strauss, José

doi:10.1007/s004670050645

Cited by 18 publications

(22 citation statements)

References 14 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is noteworthy that some nephrologists have advocated the use of captopril renograms to assist in the diagnosis of renovascular hypertension [4,16]. However, in our experience, this test is not sufficiently sensitive or specific and has not proven to be as reliable in children as in adults [17].…”

Section: Discussionmentioning

confidence: 86%

Yield of renal arteriography in the evaluation of pediatric hypertension

et al. 2000

View full text Add to dashboard Cite

The prevalence of renovascular disease is estimated to be 3%-5% in pediatric patients with hypertension. The utility of non-invasive imaging tests has not been evaluated in children, and renal arteriography remains the diagnostic test of choice. However, there are no established guidelines for the application of this test and information is not available about the likelihood of detecting an abnormality if an arteriogram is performed in children with hypertension. Therefore, we reviewed the yield of renal arteriography in pediatric patients if the test was performed based on the following two criteria: (1) severe hypertension exceeding the 99th percentile for age and sex or (2) failure to control high blood pressure with one antihypertensive drug. During the period 1983-1998, 28 children (mean age 11.7 years) who satisfied one of the above criteria underwent renal arteriography to investigate hypertension. None of the patients were renal transplant recipients. The average duration of hypertension was 11 months and the peak blood pressure was 168/107 mmHg. The renal arteriogram was abnormal in 12 patients (43%). Unilateral renal artery stenosis was the most-common abnormality. When the patients were divided into two groups - those with an abnormal or normal test result - they did not differ in age, sex, or racial distribution. The peak systolic blood pressure was higher in children with an abnormal renal arteriogram (P<0.05). Among those undergoing the arteriogram on the basis of the first criterion, i.e., severe hypertension, 11 of 23 (48%) studies were abnormal. Five children had an arteriogram based on the second criterion--failure to control the blood pressure with one medication--and in 1 patient (20%) the test was abnormal. We conclude that the prevalence of renovascular disease in a population of hypertensive children subjected to renal arteriography is around 40%. Two clinical criteria--namely severe hypertension or failure to control hypertension effectively with one drug--are useful to guide the application of renal arteriography in children with hypertension.

show abstract

Section: Discussionmentioning

confidence: 86%

Yield of renal arteriography in the evaluation of pediatric hypertension

et al. 2000

View full text Add to dashboard Cite

show abstract

“…Despite its variable sensitivity, pre-and post-captopril renal scintigraphy is widely used to detect renal artery stenosis in adults [26][27][28][29]. There is scant experience in the paediatric population, and the data are limited in children [21,28].…”

Section: Discussionmentioning

confidence: 99%

“…However, especially in infants, it is technically challenging, and the contrast material used may decrease renal function [29]. MR angiography and CT angiography have limitations in the evaluation of small accessory segmental, or intrarenal arteries, which, unfortunately, are frequently involved in infants with renal artery stenosis [22].…”

Section: Discussionmentioning

confidence: 99%

Reno-vascular hypertension in childhood: a nationwide survey

et al. 2007

View full text Add to dashboard Cite

Renovascular disease accounts for 8-10% of all cases of paediatric hypertension, whereas, in adults, its incidence is approximately 1%. The Turkish Paediatric Hypertension Group aimed to create the first registry database for childhood renovascular hypertension in Turkey. Twenty of the 28 paediatric nephrology centres in Turkey responded to the survey and reported 45 patients (27 girls, 18 boys) with renovascular hypertension between 1990 and 2005. The age at presentation ranged from 20 days to 17 years. The mean blood pressure at the diagnosis was 169/110 mmHg. Chief complaints of symptomatic patients were headache (38%), seizure (18%), epistaxis (4%), growth retardation (4%), cognitive dysfunction (4%), polyuria (2%), palpitation (2%), and hemiplegia (2%). Renovascular hypertension was found incidentally in 11 children. The diagnosis of renovascular hypertension was established with conventional angiography in 39 patients, MR angiography in three, CT angiography in two, and captopril diethylene triamine penta-acetic acid (DTPA) scintigraphy in one patient. Twenty-one children had bilateral renal artery stenosis and 24 had unilateral renal artery stenosis. Of these, 14 (31%) had fibromuscular dysplasia; 12 (27%) Takayasu's arteritis; six (13%) neurofibromatosis; two (5%) Williams syndrome; one (2%) Kawasaki disease; one (2%) mid-aortic syndrome; one (2%) extrinsic compression to the renal artery, and eight (18%) unspecified bilateral renal artery stenosis. Hypertension was controlled with antihypertensive drugs in 17 patients. Percutaneous transluminal angioplasty (PTRA) or surgery had to be performed in 28 patients: PTRA in 16 patients, PTRA + surgery in one patient and surgery in 11 patients (four nephrectomies). The importance of vasculitic disease, especially Takayasu's arteritis, should not be underestimated in children with renovascular hypertension.

show abstract

“…Most cases of hypertension in infants are caused by renovascular, renal parenchymal, or cystic disease [35]. Renovascular disorders may account for approximately one-half of the cases of neonatal hypertension [36]. Catheter-associated thromboembolic disease is the most common cause in this category.…”

Section: The Specific Case Of Renovascular Hypertension Of Infantsmentioning

confidence: 99%

Captopril-enhanced renal scintigraphy in the diagnosis of pediatric hypertension

et al. 2010

View full text Add to dashboard Cite

Hypertension in childhood is no longer a rare condition mainly secondary to renal, or renovascular diseases, as a growing proportion of children are obese and hypertensive, with the phenotype of metabolic syndrome. Thus, we need to reconsider our practice in the examination of the hypertensive child and redefine the place of non-invasive methods for screening of renovascular hypertension, and specifically, to evaluate the value of captopril-enhanced renal scintigraphy at the two ends of the palette: the obese child with hypertension and the severely hypertensive prepubertal child. Renal artery stenosis in children is mainly due to fibromuscular dysplasia and stenoses associated with syndromes involving single or multiple smaller branch vessels. This explains the low specificity and sensitivity of the color-Doppler ultrasound method and captopril renal scintigraphy. Even the more sophisticated computed tomography (CT) and magnetic resonance imaging (MRI) angiographic techniques are, at present, not sensitive enough to exclude stenoses of the small branches definitely. Thus, children in whom there is a strong suggestion of renovascular hypertension should undergo angiography with a view to endovascular treatment, as non-invasive imaging has no significant benefit and might lead to a delay in treatment. In the cases when the probability of renovascular disease is moderate a basic assessment of renal function and structure is sufficient. In the neonate, catheter-associated thromboembolic disease is among the most common causes hypertension. It should be controlled medically until the patient is old enough to undergo angiography and angioplasty successfully. Thus, in this age group, there is a place for functional imaging with renal sonography and angiotensin-converting enzyme inhibitor (ACEI) renography to detect hemodynamically significant renovascular disease, with the limitations mentioned above. However, the rapid technical evolution of non-invasive methods requires periodic re-consideration of the actual standpoints.

show abstract

ACE inhibition scintigraphy in the management of hypertension in children

Cited by 18 publications

References 14 publications

Yield of renal arteriography in the evaluation of pediatric hypertension

Yield of renal arteriography in the evaluation of pediatric hypertension

Reno-vascular hypertension in childhood: a nationwide survey

Captopril-enhanced renal scintigraphy in the diagnosis of pediatric hypertension

Contact Info

Product

Resources

About