European Journal of Pediatrics

, Volume 174, Issue 1, pp 23–32 | Cite as

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

  • J. Humbert
  • G. Roussey-Kesler
  • P. Guerin
  • T. LeFrançois
  • J. Connault
  • A. Chenouard
  • K. Warin-Fresse
  • R. Salomon
  • A. Bruel
  • E. Allain-Launay
Original Article

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.

Keywords

Renovascular hypertension Child Neurofibromatosis type 1 Fibromuscular dysplasia Angioplasty Renal artery stenosis 

Abbreviations

NF1

Neurofibromatosis type 1

PTA

Percutaneous angioplasty

RAAS

Renin-angiotensin-aldosterone system

CT

Computed tomography

MR

Magnetic resonance

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • J. Humbert
    • 1
  • G. Roussey-Kesler
    • 1
  • P. Guerin
    • 2
  • T. LeFrançois
    • 3
  • J. Connault
    • 4
  • A. Chenouard
    • 1
  • K. Warin-Fresse
    • 2
  • R. Salomon
    • 5
  • A. Bruel
    • 1
  • E. Allain-Launay
    • 1
  1. 1.Pediatric Nephrology DepartmentUniversity Hospital of NantesNantesFrance
  2. 2.Vascular DepartmentUniversity Hospital of NantesNantesFrance
  3. 3.Radiological DepartmentUniversity Hospital of NantesNantesFrance
  4. 4.Internal Medicine DepartmentUniversity Hospital of NantesNantesFrance
  5. 5.Nephrology Pediatric DepartmentUniversity Hospital of Necker Enfants MaladiesNantesFrance

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