Renal artery aneurysm repair by auto-transplantation in a 4-year-old girl with renovascular hypertension

Abstract

Hypertension is an uncommon but potentially serious finding in children. Renovascular disease is responsible for 8–10% of all cases and is treatable. We present a 4 year old girl with hypertension of 120–148 mmHg as an incidental finding while having yearly follow up due to a dermatofibroma on her back. She was otherwise well with no other significant medical issues. She received treatment with antihypertensives and multiple laboratory and imaging studies were performed; the imaging studies demonstrated a fusiform aneurysm of the left renal artery. After reviewing the images, and following discussion in a multidisciplinary team including transplant and vascular surgeons, interventional radiologists, paediatric nephrologists and a hypertension nurse specialist, a decision was taken to repair the aneurysm by performing a kidney auto-transplant. The child underwent successful surgery and on follow up she is normotensive without medications and has normal renal function. Although the technique of treating renal artery aneurysm by extracorporeal repair and auto-transplant has been described in adults, in paediatrics this is still an innovative technique. This is the first successful report of a RAA repair in the paediatric population. This is the first descriptive case report of a successful aneurysm resection and renal auto-transplant in a child.