Abstract
Renal artery stenosis (RAS) is one of the most common causes of severe arterial hypertension in infants. Its management is very difficult, especially when present in a single kidney. We report a case of severe hypertension caused by RAS of congenital single pelvic kidney in a 4-month-old boy. The patient presented with cardiorespiratory insufficiency that was first treated as acute fulminate myocarditis. Medical treatment of arterial hypertension was disappointing, as it had to be balanced between congestive cardiac failure and acute renal failure. Percutaneous transluminal angioplasty (PTA) done by coronary balloon dilatation catheters through the left axillary access was successful. Following dilatation of the renal artery, blood pressure decreased and its good control was possible by only one drug. With improved medical blood pressure control and normal growth development, the reassessment of clinical therapy options adjusted to a larger vessel size would be possible. Renovascular hypertension due to RAS in infants with a solitary kidney is difficult to control by medical treatment alone. PTA should be considered as a viable option in infants with refractory hypertension due to renal artery stenosis in a solitary kidney, since it has the potential of improving hypertension while preserving renal function.
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References
Goble MM (1993) Hypertension in infancy. Pediatr Clin North Am 40(1):105–122
Ingelfinger JR (2002) Hypertension. In: Edelmann CM Jr (ed) Pediatric kidney disease, 2nd edn. Little Brown, Boston, pp 1889–1908
Peco-Antic A (2005) Pediatric hypertensive syndrome. Therapy 2:301–309
Bendel-Stenzel M, Najarian JS, Sinaiko AR (1996) Renal artery stenosis in infants: long-term medical treatment before surgery. Pediatr Nephrol 10:147–151
Ellis D, Shapiro R, Scantlebury VP, Simmons R, Towbin R (1995) Evaluation and management of bilateral renal artery stenosis in children: a case series and review. Pediatr Nephrol 9:259–267
Dixon BP, Devarajan P, Mitsnefes M (2005) Neonatal renovascular hypertension due to prenatal traumatic retroperitoneal hematoma. Pediatr Nephrol 20:670–672
Takigiku K, Satomi G, Yasukochi S (2002) Successful transluminal angioplasty of renal arterial stenosis using the transcarotid approach. Cardiol Young 12:589–591
Kovacikova L, Kunovsky P, Skrak P, Haviar D, Martanovic P (2005) Renovascular hypertension in infant presenting with cardiogenic shock. Pediatr Emerg Care 21(5):322–324
Roth CG, Spottswood SE, Chan JC, Roth KS (2003) Evaluation of the hypertensive infant: a rational approach to diagnosis. Radiol Clin North Am 41:931–944
Cochat F, Bogaru A, MIcheli JL, Lepori D, Guignard JP (2004) Severe hypertension and massive proteinuria in a newborn with renal artery stenosis. Pediatr Nephrol 19:544–546
Shahdadpuri J, Frank R, Gauthier BG, Siegel DN, Trachtman H (2000) Yield of renal arteriography in the evolution of pediatric hypertension. Pediatr Nephrol 14:816–819
Schoenberg SO, Rieger J, Johannson LO, Dietrich O, Bock M, Prince MR, Reiser MF (2003) Diagnosis of renal artery stenosis with magnetic resonance angiography: update 2003. Nephrol Dial Transplant 18:1252–1256
Hollis HW, Rutherford RB, Crawford GJ, Cleland BP (1989) Abdominal aortic aneurysm repair in patients with pelvic kidney. Technical considerations and literature review. J Vasc Surg 9:404–409
Sebe P, Chemla E, Varkarakis J, Latremouill C (2004) Anatomic variations of the vascularization of the pelvic kidney: apropos of a case and review of the literature. Morphologie 88:24–26
Gulsun M, Balkanci F, Cekirge S, Deger A (2000) Pelvic kidney with an unusual blood supply: angiographic findings. Surg Radiol Anat 22:59–61
Glock Y, Blasevich R, Laghzaoui A, Roux D, Fournial G (1997) Abdominal aortic aneurysm and congenital pelvic kidney. A rare association. Tex Heart Inst J 24(2):131–133
Murakami T, Makino Y, Suto Y, Yasuda K (2004) Abdominal aortic aneurismal repair in a patient with a congenital solitary pelvic kidney. A case report. J Cardiovasc Surg 45:501–504
Dean P, Brancaccio C, Recchia G, Prati GF, Gulino S, Ancona G (1984) Case of renovascular hypertension caused by renal artery stenosis in congenital single kidney in pelvic ectopy. Minerva Urol Nefrol 36:135–138
Hofbeck M, Singer H, Rupprecht T, Ruder H, Schmiedl N (1998) Successful percutaneous transluminal angioplasty for treatment of renovascular hypertension in a 15-month-old child. Eur J Pediatr 157:512–514
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Peco-Antic, A., Djukic, M., Sagic, D. et al. Severe renovascular hypertension in an infant with congenital solitary pelvic kidney. Pediatr Nephrol 21, 437–440 (2006). https://doi.org/10.1007/s00467-005-2109-0
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DOI: https://doi.org/10.1007/s00467-005-2109-0