Diagnosis and Management of Renovascular Hypertension in Children

Abstract

• Over the past 15 years, we have evaluated 107 hypertensive children. A renal origin of hypertension was identified in 30 patients, and 25 have undergone operative management. In the group undergoing operation, ages ranged from 2 months to 19 years. Twelve patients were male and 13 were female. Anatomic lesions included fibromuscular dysplasia (16 patients), renal artery trauma (two patients), renal artery involvement by aortic coarctation (two patients), chronic pyelonephritis (two patients), renal hypoplasia (two patients) and contralateral renal artery stenosis after irradiation for Wilms' tumor (one patient). The rapid sequence intravenous pyelogram was abnormal in only 52%. Renal revascularization was attempted in 17 patients. Nine patients had nephrectomy and three children had segmental resections. Bilateral procedures have been performed in four children. Follow-up observations from 4 months to 13 years (mean, four years) are available. Seventeen children (68%) were cured, six (24%) improved, and two (8%) had no change in blood pressure. Both children not improved and four of the six children showing only improvement had recurrent or residual renal artery disease limiting the result. Bilateral disease has occurred in seven of the 16 children (44%) with fibromuscular dysplasia. These results support an aggressive approach to the diagnosis and management of hypertension in childhood. The bilateral nature of fibromuscular dysplasia in these children stresses the long-term superiority of revascularization over nephrectomy in their management. (Arch Surg 112:1307-1316, 1977)