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Non-invasive imaging cannot replace formal angiography in the diagnosis of renovascular hypertension

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Abstract

Objectives

Renovascular disease (RVD) is found in about 10 % of secondary childhood hypertension. Digital subtraction angiography (DSA) is the gold standard to diagnose RVD. Non-invasive imaging methods like Doppler ultrasound (US), magnetic resonance angiography (MRA), and computed tomography angiography (CTA) are increasingly used. Our aim was to evaluate the role and accuracy of US, MRA, and CTA compared to DSA in diagnosing RVD in children.

Patients and methods

A retrospective review of 127 children with suspected renovascular hypertension was performed in children referred to Great Ormond Street Hospital between 2006 and 2014 due to clinical suspicion of renovascular hypertension and/or findings on US and/or MRA or CTA.

Results

Ninety-nine of 127 children (78 %) were diagnosed with renovascular disease and 80 were treated with percutaneous transluminal angioplasty during the same procedure. The median age at presentation was 5.6 (range, 2.5–10.6) years. Thirty-six children had unilateral renal artery stenosis in major extraparenchymal vessels, 47 bilateral stenosis and 16 intrarenal small vessel disease. US had a sensitivity of 63 % and specificity of 95 %. MRA and CTA were performed in 39 and 34 children, respectively. CTA sensitivity was slightly higher than that of MRA, 88 vs. 80 %, and specificity 81 vs. 63 %.

Conclusions

The sensitivity of MRA and CTA is still too low to reliably rule out renovascular disease in children with a strong suspicion of this diagnosis. DSA remains the gold standard to diagnose renovascular hypertension and is recommended when clinical and laboratory criteria are highly suggestive of renovascular disease even with normal radiological investigations from non-invasive methods.

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Abbreviations

CTA:

Computed tomography angiography

DSA:

Digital subtraction angiography

GOSH:

Great Ormond Street Hospital London

IQR:

Interquartile range

MRA:

Magnetic resonance tomography

RAS:

Renal artery stenosis

RVD:

Renovascular disease

US:

Doppler ultrasound

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Contributors’ statements

Agnes Trautmann: Dr. Trautmann designed the data collection, collected the data, carried out the initial analyses, drafted the initial manuscript and approved the final manuscript as submitted.

Derek Roebuck: Dr. Roebuck reviewed and revised the manuscript, and approved the final manuscript as submitted.

Clare A. McLaren: Ms. McLaren reviewed and revised the manuscript and approved the final manuscript as submitted.

Eileen Brennan: Ms. Eileen Brennan reviewed and revised the manuscript and approved the final manuscript as submitted.

Kjell Tullus: Dr. Tullus conceptualized and designed the study, supervised data collection, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Author information

Authors and Affiliations

  1. Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK

    Agnes Trautmann, Eileen Brennan, Stephen D. Marks & Kjell Tullus

  2. Department of Pediatric Nephrology, University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany

    Agnes Trautmann

  3. Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK

    Derek J. Roebuck & Clare A. McLaren

Authors
  1. Agnes Trautmann
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Correspondence to Kjell Tullus.

Ethics declarations

The retrospective study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

For this type of study formal consent is not required.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Trautmann, A., Roebuck, D.J., McLaren, C.A. et al. Non-invasive imaging cannot replace formal angiography in the diagnosis of renovascular hypertension. Pediatr Nephrol 32, 495–502 (2017). https://doi.org/10.1007/s00467-016-3501-7

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  • DOI: https://doi.org/10.1007/s00467-016-3501-7

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