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Diagnostic and medical strategy for renovascular hypertension: report from a monocentric pediatric cohort

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Abstract

Renovascular hypertension accounts for 5–10 % of hypertension cases in children; there is currently no consensus on treatment. Here, we report on our clinical experience with this disease and outline the different pathways in which to investigate it. We report retrospectively on ten children diagnosed with renovascular hypertension at the University Hospital of Nantes from 2001 to 2012. The main findings were obtained by fortuitous screening of children aged 2 months to 14 years old with neurofibromatosis (n = 2) and fibromuscular dysplasia (n = 8). The hypertension was always severe yet asymptomatic. Lesions were complicated in nine out of ten cases and included bilateral, multiple, mid-aortic syndrome and aneurysm. Doppler ultrasound associated with computed tomography allowed for a precise diagnosis in seven out of ten cases. Where ambiguities persisted, they were highlighted by arteriography, the gold standard investigation. Medical treatment was insufficient, leading to invasive procedures in nine out of ten children: 2 nephrectomies, 2 autotransplantations, and 21 repetitive percutaneous transluminal angioplasties. After invasive procedures, blood pressure control improved in four cases and was resolved in three. Conclusion: Arteriography remains to be the gold standard technique for renovascular hypertension in children and can be combined with angioplasty when medical treatment is rendered obsolete. The role of computed tomography is controversial. Despite the heterogeneity of the children studied, we present a general medical and therapeutic management pathway for the treatment of this disease.

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Abbreviations

NF1:

Neurofibromatosis type 1

PTA:

Percutaneous angioplasty

RAAS:

Renin-angiotensin-aldosterone system

CT:

Computed tomography

MR:

Magnetic resonance

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Acknowledgments

We would like to thank Dr. Sophie Minguet (Koonec, Scientific and Medical Translation, Barcelona, Spain) for editing the paper.

Conflict of interest

The authors have neither conflict of interest nor any financial relationship to disclose.

Author information

Authors and Affiliations

  1. Pediatric Nephrology Department, University Hospital of Nantes, Nantes, France

    J. Humbert, G. Roussey-Kesler, A. Chenouard, A. Bruel & E. Allain-Launay

  2. Vascular Department, University Hospital of Nantes, Nantes, France

    P. Guerin & K. Warin-Fresse

  3. Radiological Department, University Hospital of Nantes, Nantes, France

    T. LeFrançois

  4. Internal Medicine Department, University Hospital of Nantes, Nantes, France

    J. Connault

  5. Nephrology Pediatric Department, University Hospital of Necker Enfants Maladies, Nantes, France

    R. Salomon

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  1. J. Humbert
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  2. G. Roussey-Kesler
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  3. P. Guerin
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  4. T. LeFrançois
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  5. J. Connault
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  9. A. Bruel
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  10. E. Allain-Launay
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Correspondence to E. Allain-Launay.

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Communicated by Jaan Toelen

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Humbert, J., Roussey-Kesler, G., Guerin, P. et al. Diagnostic and medical strategy for renovascular hypertension: report from a monocentric pediatric cohort. Eur J Pediatr 174, 23–32 (2015). https://doi.org/10.1007/s00431-014-2355-x

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  • DOI: https://doi.org/10.1007/s00431-014-2355-x

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