Abstract
Background and Aims
Renovascular disease is rare but important treatable cause of secondary hypertension in children. We aimed to evaluate the clinical presentations and long-term outcomes of pediatric patients with renovascular hypertension (RVH).
Method
We retrospectively reviewed medical records of patients with renovascular disease at our center between 1994 and 2019. Clinical courses including status of hypertension control with preservation of renal function during follow up were evaluated.
Results
20 patients were diagnosed with RVH. 50 % (n = 10) were male, and median age at diagnosis was 10.1 (range 1.3 – 17.2) years, and median follow up period was 8.7 (range 0.1 – 24.6) years. 50 % (n = 10) presented with incidently detected high blood pressure (8 patients without symptoms, one with headache, and the other one with proteinuria), 25 % (n = 5) first admitted due to heart failure symptoms, and the rest (25 %, n = 5) presented with neurologic symptoms including seizure or paraplegia. Majority had no underlying disease except for 3 patients with Moyamoya disease. 80 % (n = 16) had unilateral renovascular stenosis. All patients showed elevated basal random renin activity (median 20.0, range 2.5 – 62.1 ng/ml/hr), and 45 % (n = 9) patients showed elevated basal random aldosterone level (median 822, range 266 – 2440 pg/ml). All patients needed antihypertensive medications for blood pressure control; 35 % (n = 7) of patients gained good control of blood pressure only with antihypertensive agents including angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), 40 % (n = 8) of patients who underwent percutaneous transluminal angioplasty all still needed antihypertensive agents including ACEI for blood pressure control. 20 % (n = 4) of the patients initially showed profoundly low relative function of involved kidney on diuretic scan, leading to nephrectomy. Three of these patients with nephrectomy successfully discontinued all antihypertensive agent gaining good control of blood pressure. The remaining one patient showed progressive deterioration of relative function on the involved side of kidney during 13 years, ended up with nephrectomy, but couldn’t discontinue ACEI. Glomerular filtration rate (GFR) was within normal range for all patients at diagnosis. For patients without nephrectomy, mean relative function of the involved kidney on diuretic scan was 33.5 ± 11.4 % at diagnosis. There was no significant change or deterioration of relative renal function during a mean follow up period of 10 ± 8 (median 11.5, range 0 – 19.5) years, although they all used ACEI/ARB.
All patients including patients with nephrectomy showed normal GFR with a mean of 114.1 ± 19.5 ml/min/1.73 m2 at the last follow up.
Conclusion
Antihypertensive medications including ACEI and ARB were safely used with no further deterioration of the renal function of the involved side with or without angioplasty. Pediatric RVH is well managed with preserved renal function in long-term follow up.
Blood Pressure Control: Stroke and Stroke Prevention
