Angioplasty for pediatric renovascular hypertension: a 13-year experience

Abstract

ORIGINAL ARTICLE PURPOSE We aimed to evaluate the long-term outcome and efficacy of percutaneous transluminal renal angioplasty (PTRA) for pediatric renal artery stenosis (RAS), which is an important cause of medication-refractory pediatric hypertension. MATERIALS AND METHODSWe retrospectively evaluated 22 hypertensive children (age range, 3-17 years) who underwent PTRA from February 2000 to July 2012. Sixteen patients had Takayasu arteritis and six fibromuscular dysplasia. Five were not included in the statistical analysis due to loss to follow-up. RESULTSTechnical success was achieved in 32 of 34 procedures (94.1%). The stenosis rate decreased from 84.5% before PTRA to 20.1% after PTRA. Treatment was effective in 72.7% (16/22) of patients, including complete cure in 27.3% (6/22) and improvement in 45.5% (10/22). Systolic and diastolic blood pressures decreased from 153±19.1 to 131.7±21.4 mmHg and from 97.9±14.2 to 83.6±19.3 mmHg, respectively (P < 0.01). Number of antihypertensive agents decreased from 2.7 to 0.5 per patient. Restenosis was detected in 40.9% (9/22) of patients, with a restenotic interval of 11.8 months (range, 3-47 months). Lesion length was strongly correlated with clinical success (cure and improvement) (independent-sample t test, P < 0.001; binary logistic regression, P = 0.040). CONCLUSIONLesion length is an important determination of clinical success with PTRA for pediatric RAS. PTRA is an appropriate treatment option for pediatric renovascular hypertension due to Takayasu arteritis and fibromuscular dysplasia.

Long-Term Outcomes of Pediatric Renovascular Hypertension

“…While RVHT is a well-known cause of secondary hypertension in childhood, at the time of referral, many of the affected kidneys were already smaller than normal, implying a delayed diagnosis. In this study, we assessed changes in the size of the affected kidneys over time according to the treatment modality; this approach differentiates our study from previous reports on pediatric RVHT [3,10,11,13,[26][27][28]. Indeed, kidney sizes decreased in some patients over time.…”

“…TA was diagnosed if there were typical angiographic abnormalities of narrowing or occlusion of the entire aorta and/or its primary branches, or large arteries in the proximal upper or lower extremities in addition to RAS, as according to known diagnostic criteria of TA [20,21]. A diagnosis of FMD was made in patients who had no evidence of other vasculitis and had a "string of beads" appearance or focal lesions in the middle or distal segments of the renal artery on angiographic images [9,10,22]. Using well-known diagnostic criteria, patients whose cerebral angiography showed stenosis or occlusion at the terminal portion of the internal carotid artery (ICA) and/or at the proximal portion of the anterior cerebral arteries (ACAs) and/or the middle cerebral artery (MCA), as well as abnormal vascular networks in the vicinity of the occlusive or stenotic lesions in the arterial phase, were categorized as having MMD [23].…”

“…Several studies have assessed the effect of RVHT treatment on blood pressure (BP) control and changes in estimated glomerular filtration rate (eGFR) [3,8,[10][11][12][13]. However, the progression in renal atrophy and the change in kidney size in RVHT have rarely been investigated [6].…”

“…RVHT can occur in isolation as a result of fibromuscular dysplasia (FMD) of the renal arteries, as a symptom of systemic vasculitis such as Takayasu's arteritis (TA) or polyarteritis nodosa (PAN), or as an extracranial manifestation of Moyamoya disease (MMD) [7,8]. FMD is the most prevalent cause of RVHT in Western countries; in Asia, however, TA has been reported to be a more common cause [9,10]. RVHT treatment options include antihypertensive medication; endovascular intervention, such as percutaneous transluminal angioplasty; and surgical intervention, including revascularization surgery or unilateral nephrectomy.…”

Renal Autotransplantation in a Patient With Resistant Renal Artery Stenosis

“…For FMD, aortoarteritis and mid-aortic syndrome, long-term results of PTRA are good, whereas PTRA performed in patients with underlying neurofibromatosis does not have good results [5]. The renal artery restenosis rate in children varies between 7.4% and 40.9%, and restenosis occurs several months after an initial PTRA [6,7].…”