Diagnostic and medical strategy for renovascular hypertension: report from a monocentric pediatric cohort

Humbert, J; Roussey-Kesler, Gwénaëlle; Guérin, Patrice; Lefrançois, T.; Connault, J.; Chenouard, Alexis; Warin-Fresse, K.; Salomon, Rémi; Bruel, Alexandra; Allain-Launay, Emma

doi:10.1007/s00431-014-2355-x

Cited by 20 publications

(9 citation statements)

References 41 publications

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“…Renal artery stenosis is a possible cause of HT and has been observed in about 3% to 10% of cases of pediatric HT [15,16]. NB causing renovascular HT owing to extrinsic aortic narrowing and/or stenosis of the renal artery has been reported [2,5].…”

Section: Abstract a R T I C L E I N F Omentioning

confidence: 99%

Perioperative management of hypertensive neuroblastoma: A study from the Italian Group of Pediatric Surgical Oncologists (GICOP)

Pio

Avanzini

Mattioli

et al. 2017

Journal of Pediatric Surgery

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Background: Hypertension (HT) is rarely reported in patients affected by Neuroblastoma (NB), and management guidelines are lacking. Clinical features and perioperative medical treatment in such patients were reviewed to 1) ascertain whether a shared treatment strategy exists among centers and 2) if possible, propose some recommendations for the perioperative management of HT in NB patients. Methods: A retrospective multicenter survey was conducted on patients affected by NB who presented HT symptoms. Results: From 2006 to 2014, 1126 children were registered in the Italian Registry of Neuroblastoma (RINB). Of these, 21 with HT (1.8%) were included in our analysis. Pre-and intraoperative HT management was somewhat dissimilar among the participating centers, apart from a certain consistency in the intraoperative use of the alpha-1 blocker urapidil. Six of the 21 patients (28%) needed persistent antihypertensive treatment at a median follow-up of 36 months (range 4-96 months) despite tumor removal. Involvement of the renal pedicle was the only risk factor constantly associated to HT persistency following surgery. A correlation between the presence of HT and the secretion of specific catecholamines and/or compression of the renal vascular pedicle could not be demonstrated.

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Section: Abstract a R T I C L E I N F Omentioning

confidence: 99%

Perioperative management of hypertensive neuroblastoma: A study from the Italian Group of Pediatric Surgical Oncologists (GICOP)

Pio

Avanzini

Mattioli

et al. 2017

Journal of Pediatric Surgery

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“…The indication for treatment was therefore strong. The literature on percutaneous transluminal angioplasty in small children is limited, with only some case reports and very few patients in some retrospective series [2,9,10,[15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, there are very few patients under the age of 2 years [4,9,10] and there are no published studies focusing on the outcome in small children. The aim of this study was therefore to retrospectively evaluate the presentation, treatment, and outcome of children younger than 2 years of age who underwent diagnostic angiography as investigation of arterial hypertension at our institution.…”

Section: Introductionmentioning

confidence: 99%

Presentation, treatment, and outcome of renovascular hypertension below 2 years of age

et al. 2022

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Renovascular hypertension in most cases requires endovascular treatment and/or surgery. This is technically much more difficult in small children and there is very limited published knowledge in this age group. We here present treatment and outcome of young children with renovascular hypertension at our institution. Children below 2 years of age, with renovascular hypertension between January 1998 and March 2020 were retrospectively reviewed. Demographics and treatment modalities were noted. Primary outcome was blood pressure within a week after the procedures and at last available visit. Sixty-six angiographies were performed in 34 patients. Median age at time of first angiography was 1.03 (interquartile range (IQR) 0.4–1.4) years and systolic blood pressure at presentation 130 (IQR 130–150) mm Hg. Thirty-eight percent (13/34) of children were incidentally diagnosed and 18% (6/34) presented with heart failure. Twenty-six (76%) children had main renal artery stenosis and 17 (50%) mid-aortic syndrome. Seventeen (50%) children showed intrarenal, six (18%) mesenteric, and three (9%) cerebrovascular involvement. Twenty patients underwent 45 percutaneous transluminal angioplasty procedures and seven children surgeries. In 44% of the 16 patients who underwent only percutaneous transluminal angioplasty blood pressure was normalized, 38% had improvement on same or decreased treatment and 19% showed no improvement. Complications were seen in 7.5% (5/66) of angiographies. In four of the seven (57%) children who underwent surgery blood pressure was normalized, two had improved (29%) and one unchanged (14%) blood pressure.Conclusion: In small children with renovascular hypertension below the age of 2 years, percutaneous transluminal angioplasty caused significant improvement in blood pressure with low complication profile. Surgery can be recommended where percutaneous transluminal angioplasty and medical treatments failed. What is Known:• Renovascular hypertension is diagnosed in all age groups from a few weeks of life until adulthood.• Both angioplasty and surgery are significantly more difficult to perform in small children and the published information on short and long-term outcome in these children is very scarce. What is New:• Children below the age of two years can safely and successfully undergo selective renal angiography and also safely be treated with angioplasty.• We here present a large group of babies and infants where angioplasty and in some cases surgery effectively and safely improved their blood pressure.

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“…For these reasons, it is not universally performed for the evaluation of pediatric hypertension. Several non-invasive methods have been recommended for evaluation of RVH in children, but their specificity and sensitivity varies widely [7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

The role of a captopril renal scintigraphy in examination of children with hypertension: A case report

et al. 2018

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Introduction. Secondary hypertension is a relatively common form of hypertension in childhood with renovascular hypertension being responsible for 5%-10% of all arterial hypertensions in children. An early diagnosis of renovascular hypertension is important when considering an appropriate treatment of hypertension that may prevent or slow further progression of kidney damage. To validate the usefulness of a captopril renal scintigraphy in hypertensive children, we report a case of a 16-year-old female patient with a history of hypertension as a result of fibromuscular dysplasia. Case report. The patient was asymptomatic with elevated blood pressure revealed by a routine physical examination. Laboratory tests showed the increased levels of plasma renin activity with the normal levels of aldosteron. The renal ultrasound was normal. The Doppler of the renal arteries showed no significant differences of resistive index. A renal captopril scintigraphy was performed, including two day study protocol, the baseline study followed by another captopril study several days later. The scintigraphy showed the abnormal baseline and captopril renogram curve of the right kidney with significant cortical retention of radiotracer after angiotensin-converting enzyme inhibition. Following the captopril scintigraphy a renovasography was obtained confirming the presence of a 2 mm long circular narrowing of the right renal artery. It was immediately treated resulting in a significant expansion of the lumen. Conclusion. The captopril renal scintigraphy allows non-invasive functional testing in a selected group of hypertensive children, which can either confirm or rule out the existence of hemodynamically significant renal artery stenosis.

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Diagnostic and medical strategy for renovascular hypertension: report from a monocentric pediatric cohort

Cited by 20 publications

References 41 publications

Perioperative management of hypertensive neuroblastoma: A study from the Italian Group of Pediatric Surgical Oncologists (GICOP)

Perioperative management of hypertensive neuroblastoma: A study from the Italian Group of Pediatric Surgical Oncologists (GICOP)

Presentation, treatment, and outcome of renovascular hypertension below 2 years of age

The role of a captopril renal scintigraphy in examination of children with hypertension: A case report

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