Renovascular hypertension in children

Premal Amrishkumar Patel,Anne Marie Cahill

doi:10.1186/s42155-020-00176-5

Abstract

Paediatric hypertension, defined as systolic blood pressure > 95th percentile for age, sex and height is often incidentally diagnosed. Renovascular hypertension (RVH) is responsible for 5–25% of hypertension in children. Renal artery stenosis and middle aortic syndrome can both can be associated with various conditions such as fibromuscular dysplasia, Williams syndrome & Neurofibromatosis type 1. This paper discusses the approaches to diagnosis and interventional management and outcomes of renovascular hypertension in children. Angiography is considered the gold standard in establishing the diagnosis of renovascular disease in children. Angioplasty is beneficial in the majority of patients and generally repeated angioplasty is considered more appropriate than stenting. Surgical options should first be considered before placing a stent unless there is an emergent requirement. Given the established safety and success of endovascular intervention, at most institutions it remains the preferred treatment option.

Highlights

Paediatric hypertension is defined as systolic blood pressure > 95th percentile for age, sex and height (National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents 2004)
In the few series reporting cutting balloon angioplasty in children, in view of increased risk of complications such as dissection and renal artery aneurysm, cutting balloon diameter is recommended to be limited to no more than the normal vessel diameter in the incisional phase after which further dilation can be performed with a conventional balloon if required (Alexander et al 2017; Towbin et al 2007)
Current literature supports an endovascular approach for investigation and management of renovascular hypertension in children

Summary

Introduction

Paediatric hypertension is defined as systolic blood pressure > 95th percentile for age, sex and height (National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents 2004). Angiography Children who are thought to have a high probability of renovascular disease, for example those with normal body mass index, no family history, elevated renin, hypertension requiring multiple medications should undergo angiography with a view to endovascular treatment regardless of findings of non-invasive imaging (Fig. 1) (Tullus et al 2008; Louis et al 2018; Trautmann et al 2017; Tullus 2011).

Results

Conclusion