Long-Term Outcomes of Pediatric Renovascular Hypertension

Abstract

Background/Aims: Renovascular hypertension (RVHT) is an important cause of childhood hypertension. This study evaluated the clinical characteristics and outcomes of Korean children with RVHT. Methods: Children treated for RVHT between 2000 and 2015 at our center were retrospectively reviewed. Results: Forty-six children were followed for a median of 6.5 (0.66-27.23) years. Forty-five percutaneous transluminal angioplasties (PTAs) were performed in 32 children. At the last visit, clinical benefit was observed in 53.3% of children. Patients with comorbid cerebrovascular disease (CVD) showed less favorable long-term outcomes after PTA (clinical benefit in 41.7% vs. 61.1% in others) and higher restenosis rates (50% vs. 31.6% in others). Surgical procedures (bypass or nephrectomy) were performed in 8 patients. After surgery, blood pressure was normalized in 2 patients, improved in 3 patients, and unchanged in the remaining patients. Between PTA group (n=21) and medication group (n=14), percentage of atrophic kidneys became higher after follow-up period in medication group than in PTA group (60.0% vs. 26.1%, P=0.037). Conclusion: Aggressive treatment of pediatric RVHT yielded fair outcomes in our cohort. CVD comorbidity was associated with relatively poor PTA outcomes. To confirm our findings, larger cohort studies with a longer follow-up period are warranted.

Long-term outcomes of angioplasty for pediatric renovascular hypertension: A single-center experience

“…6,9 In previous reports, the effective rate of PTA for pediatric RVH was 53.3-90% (cured: 13.3-50% and improved: 39.7-50%). 6,9,[13][14][15] With respect to the underlying etiology, the effective rate was 68.8-100% in children with TA and 70-100% in children with FMD. 6,13,14 The efficacy of PTA in pediatric RVH patients and the reintervention rates in previous studies show some variability; this is likely attributable to the differences in race, sample size, distribution of underlying etiology, procedure details, and the duration of follow-up.…”

Surgical management of pediatric renin-mediated hypertension secondary to renal artery occlusive disease and abdominal aortic coarctation

“…To date, there are no randomized trials comparing medical management with surgical revascularization for pediatric RVH. 1,[3][4][5][6][7][8] Moreover, the role of endovascular interventions as a first-line or "bridging" option for treatment of pediatric RVH has not been defined. [9][10][11][12][13] A previous report from the University of Michigan on the surgical treatment of 97 children having RVH demonstrated a 97% benefit for blood pressure control.…”

An unusual cause of renovascular hypertension in a pediatric patient with chronic kidney disease

“…Renovascular hypertension (RVH) comprises 5-10% of cases of pediatric hypertension [5]. The most common cause of RVH in pediatric patients is fibromuscular dysplasia in Europe and North America and Takayasu arteritis in Asia and Africa [6][7][8]. Other causes of RVH include renal artery thrombosis (e.g., as a consequence of renal artery catheterization), congenital stenosis/hypoplasia of the renal artery, neurofibromatosis type 1, tuberous sclerosis complex, Williams-Beuren, Alagille, and Grange syndromes, other forms of arteritis (e.g., polyarteritis nodosa), and extrinsic compressive masses [2,5,[7][8][9].…”