Renovascular hypertension in pediatric patients: update on diagnosis and management

Campos, Juliana Lacerda de Oliveira; Bitencourt, Letícia; Pedrosa, Ana Luisa; Silva, Diego Ferreira; Lin, Filipe Ji Jen; Dias, Lucas Teixeira de Oliveira; Silva, Ana Cristina Simões e

doi:10.1007/s00467-021-05063-2

Cited by 11 publications

(8 citation statements)

References 111 publications

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“…If suspicion of reno‐vascular hypertension persists after initial work‐up, further investigation of the renal vasculature can be pursued. Doppler evaluation is readily available, although identification of stenosis of accessory, branch, and intrarenal renal arteries may be limited with this modality; CT and MRI have better and more specific rates of detection but may require sedation in younger age groups 17 . Generally, these can be delayed until after blood pressure is better controlled.…”

Section: Discussionmentioning

confidence: 99%

“…Doppler evaluation is readily available, although identification of stenosis of accessory, branch, and intrarenal renal arteries may be limited with this modality; CT and MRI have better and more specific rates of detection but may require sedation in younger age groups. 17 Generally, these can be delayed until after blood pressure is better controlled. Consequences of long-standing hypertension, such as left ventricular hypertrophy, can be diagnosed via TTE, which would show thickened muscle tissue in the left ventricle and provide a better understanding of the duration of hypertension.…”

Section: (A) (B)mentioning

confidence: 99%

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A rare cause of posterior reversible encephalopathy syndrome: Acute lymphoblastic leukemia

Hayes,

Mahoney,

Ayers

et al. 2023

Clinical Case Reports

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Key Clinical MessageThe presentation of posterior reversible encephalopathy syndrome (PRES) as the initial presenting sign of acute lymphoblastic leukemia is unusual, as PRES is more often a complication of therapy. This case highlights the importance of maintaining a broad differential diagnosis for pediatric hypertension and its complications.AbstractA 6‐year‐old male presented with a seizure‐like episode. Evaluation revealed hypertension and brain imaging showed findings consistent with posterior reversible encephalopathy syndrome. Complete blood count showed lymphoblasts, and the cause of his hypertension was determined to be renal infiltration of leukemia cells due to B‐cell acute lymphoblastic leukemia.

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Section: Discussionmentioning

confidence: 99%

Section: (A) (B)mentioning

confidence: 99%

A rare cause of posterior reversible encephalopathy syndrome: Acute lymphoblastic leukemia

Hayes,

Mahoney,

Ayers

et al. 2023

Clinical Case Reports

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“…RAS is one of the common vascular diseases causing hypertension in children. 4 However, renal artery aneurysms and AAAs, which can be components of MAS, are rarely associated with RAS. Early diagnosis and treatment are critical to prevent serious complications.…”

Section: Discussionmentioning

confidence: 99%

“…The most common of these vascular diseases are aortic coarctation or dissection, fibromuscular dysplasia, some syndromic disorders (Williams syndrome, neurofibromatosis, Turner syndrome), tumour compression (Wilm's tumour, neuroblastoma, lymphoma) and some large vessel vasculitis (Takayasu arteritis, Polyarteritis nodosa, Moyamoya disease). 4,5 In addition, mid-aortic syndrome (MAS) which affects children and young adults, is characterized by narrowing of the thoracic aorta and/or abdominal aorta, may be a serious cause of renovascular hypertension in association with anomalies of the visceral arteries, especially the renal arteries. 6 In this case report, we aimed to present a rare treatment method using a saphenous vein from his father in a 5-year-old boy who presented with hypertension with MAS.…”

Section: Introductionmentioning

confidence: 99%

A rare cause and an even rarer treatment of hypertension in a 5‐year‐old boy: Mid‐aortic syndrome

İriz,

Tak,

Yiğiter

et al. 2023

Nephrology

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Renal artery stenosis is one of the common vascular diseases that cause hypertension in children. However, renal artery aneurysms and abdominal aortic aneurysms, which may be components of mid‐aortic syndrome, are rarely associated with renal artery stenosis. Despite its rarity, early diagnosis and treatment are critical to prevent fatal complications. Currently, non‐surgical invasive techniques are considered the first choice for treatment, but in some cases, surgery is inevitable. Here, we present a 5‐year‐old boy with a mid‐aortic syndrome. The patient presented with a history of severe headache and epistaxis 5–6 times a day and was diagnosed with hypertension. A 9 × 9 mm saccular aneurysm on the anterior surface of the abdominal aorta at the level of the left renal artery ostium, and a 12 mm aneurysm in the left renal artery after a stenotic segment at the hilum level was detected in the doppler USG and contrast‐enhanced imaging techniques. The patient was operated on electively. We used a PTFE patch to repair the abdominal aorta and, saphenous vein which was taken from his father to repair the renal artery. The patient recovered well and was discharged on the 18th day.image

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“…However, there have not been any reports of 3D model printing being used for children undergoing surgical interventions for abnormal arterial vasculature such as that seen in renovascular hypertension (RVH). RVH is characterised most commonly by renal artery stenosis causing an upregulation in the renin–angiotensin aldosterone system, leading to hypertension with multisystem consequences 12 13. Up to 5% of hypertension in children is caused by RVH, and the hypertension is often uncontrolled on antihypertensives, therefore requiring endovascular or surgical interventions 14.…”

Section: Introductionmentioning

confidence: 99%

3D printing: a useful tool for safe clinical practice in children with complex vasculature

Paessler,

Forman,

Minhas

et al. 2024

Arch Dis Child

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Background3D printing has been used in different medical contexts, although it is underutilised in paediatrics. We present the first use of 3D printing in the management of three paediatric patients with complex renovascular disease.MethodsPatient-specific 3D models were produced from conventional 2D imaging and manufactured using 3D polyjet printing technology. All three patients had different underlying pathologies, but all underwent multiple endovascular interventions (renal artery balloon angioplasty) prior to 3D printing and subsequent vascular surgery. The models were verified by an expert radiologist and then presented to the multidisciplinary team to aid with surgical planning.ResultsFollowing evaluation of the 3D-printed models, all patients underwent successful uni/bilateral renal auto-transplants and aortic bypass surgery. The 3D models allowed more detailed preoperative discussions and more focused planning of surgical approach, therefore enhancing safer surgical planning. It influenced clinical decision-making and shortened general anaesthetic time. The families and the patients reported that they had a significantly improved understanding of the patient’s condition and had more confidence in understanding proposed surgical intervention, thereby contributing to obtaining good-quality informed consent.Conclusion3D printing has a great potential to improve both surgical safety and decision-making as well as patient understanding in the field of paediatrics and may be considered in wider surgical areas.

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Renovascular hypertension in pediatric patients: update on diagnosis and management

Cited by 11 publications

References 111 publications

A rare cause of posterior reversible encephalopathy syndrome: Acute lymphoblastic leukemia

A rare cause of posterior reversible encephalopathy syndrome: Acute lymphoblastic leukemia

A rare cause and an even rarer treatment of hypertension in a 5‐year‐old boy: Mid‐aortic syndrome

3D printing: a useful tool for safe clinical practice in children with complex vasculature

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