Renovascular Hypertension in Children: Evaluation and Management

Abstract

Renal artery stenosis is an unusual but important cause of high blood pressure (BP) in children. It often presents with very severely raised BP and symptoms of target organ damage. The cause is unknown in most cases, but fibromuscular dysplasia and Takayasu arteritis are the most common depending on the child’s geographic location. A minority of cases are related to syndromes, mainly Neurofibromatosis type 1 and Williams syndrome. Ultrasound and CT angiography are used in the initial investigation, but digital subtraction angiography is the gold standard investigation. Medical treatment rarely achieves adequate BP control, and the most commonly used treatment is angioplasty. Vascular surgery such as arterial bypass or autotransplantation of the kidneys is used in a significant minority of children. Outcomes of angioplasty, including restoration of renal blood flow and improvement of BP, are good in the majority of children, but there is a significant minority where current treatment options are ineffective in achieving a sustained BP control and preventing end organ damage.