Renovascular Hypertension

Wise, Kendall L.; McCann, Richard L.; Dunnick, N. Reed; Paulson, David F.

doi:10.1016/s0022-5347(17)41890-8

Cited by 32 publications

(11 citation statements)

References 73 publications

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“…This explains the discrepancy between our current and previous data [14] in the context of sensitivity and specificity of the test in recognising the potential for cure following surgery. False-negative results for RVR ratio have been more commonly reported for fibromuscular disease [41], which accounts for the majority of RVD in children [42,43,44]. This may also have contributed to the poor specificity of our RVR results.…”

Section: Discussionmentioning

confidence: 84%

The usefulness of renal vein renin studies in hypertensive children: a 25-year experience

Goonasekera

Shah

Wade

et al. 2002

Pediatric Nephrology

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Lateralised renin secretion predicts improvement following surgery/angioplasty of the affected kidney in paediatric hypertension. We retrospectively analysed all our renal vein renin (RVR) studies undertaken in hypertensive children and their subsequent clinical outcomes over a 25-year period. The outcomes were categorised as cure, improvement or no change in hypertension. The proportions that benefited by 'following' or 'ignoring' the RVR results in relation to the aetiology of hypertension and subsequent therapy were compared. A ratio between the RVR value of the dominant kidney and that of the contralateral kidney (R/Rc ratio) above 1.5 was considered to show significant lateralisation. A ratio between RVR value of the contralateral kidney and that of the caudal inferior vena cava (Rc/P ratio) of less than 1.3 was considered to indicate contralateral renin suppression. Of 233 RVR records, 137 were suitable for analysis. Of these, 39 had reflux nephropathy (RN), 73 renovascular disease (RVD) and the others miscellaneous conditions. Of the 39 hypertensive children with RN, the R/Rc ratio was over 1.5 in 20 subjects, of whom 11 underwent surgery. Amongst the 19 with an R/Rc less than 1.5, 4 also had surgery. Of the 73 hypertensive children with RVD, the R/Rc ratio was over 1.5 in 38 subjects, of whom 20 underwent surgery/angioplasty. Amongst the 35 with an R/Rc less than 1.5, 7 also underwent surgery/angioplasty. In RN there was no significant difference in the proportion that improved with allocated treatment, as suggested by the 'test' when compared with those who were 'misallocated'. In RVD, however, the proportion improved (35.0%) by 'following the test' (i.e. R/Rc ratio) was significantly greater than the proportion improved (12.5%) in the group in whom the test was 'ignored'. This was true for both R/Rc and Rc/P ratios. Thus, RVR measurements are useful for identifying hypertensive children with RVD that may have a favourable outcome after surgery, but this does not apply to children with RN. Measurements, however, may have diagnostic value even if surgery or angioplasty is not anticipated.

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Section: Discussionmentioning

confidence: 84%

The usefulness of renal vein renin studies in hypertensive children: a 25-year experience

Goonasekera

Shah

Wade

et al. 2002

Pediatric Nephrology

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“…Surgical techniques depend on the type of arterial lesion; the most commonly used operation of lesion of the trunk of the renal artery is the aortorenal bypass [23,25], In our experience, renal autotrans plantation has superior results to those of the bypass technique [26], When arterial lesion involves the renal artery and its branches or in the case of polar arteries, extracorporeal techniques are used, the operating field is superficial and the use of microsurgical techniques is possible, achieving the best conditions for anastomosis. Further…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Repair of Primary Renal Artery Dissection

Martín¹,

Salas²,

Bouvier³

et al. 1993

Eur Urol

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“…The most common condition causing renovascular disease in childhood is fibromuscular dysplasia, which is reported in approximately 70% of patients with renovascular hypertension [12,14,18,19]. This is in contrast to the situation in adults, where 60% of cases of renovascular disease are due to atherosclerosis at the ostium or on the main branch of the renal artery [20,21]. Other cases of pediatric renal artery stenosis (RAS) are associated with established disorders, including vasculitides (Takayasu disease, Moya-Moya), syndromes (Turner, Marfan, Williams, Klippel-Trenaunay-Weber, mid-aortic), neurofibromatosis and previous renal artery surgery.…”

Section: Etiology Of Renal Artery Stenosis In Children and Its Implimentioning

confidence: 99%

Captopril-enhanced renal scintigraphy in the diagnosis of pediatric hypertension

et al. 2010

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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.

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Renovascular Hypertension

Cited by 32 publications

References 73 publications

The usefulness of renal vein renin studies in hypertensive children: a 25-year experience

The usefulness of renal vein renin studies in hypertensive children: a 25-year experience

Extracorporeal Repair of Primary Renal Artery Dissection

Captopril-enhanced renal scintigraphy in the diagnosis of pediatric hypertension

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