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Impact of revascularization on hypertension in children with Takayasu’s arteritis-induced renal artery stenosis: a 21-year review

Abstract

Background

Surgery for reno-vascular hypertension (RVH) is complex, and the techniques utilized vary with anatomical presentations of the disease. The long-term outcome of revascularization on RVH in children with Takayasu’s arteritis (TA)-induced renal artery stenosis (RAS) at our centre was reviewed.

Methods

This study was a 21-year retrospective review of pre- and post-intervention RVH in children with angiographically confirmed RAS. The outcome of hypertension was defined as follows: (1) cured (normotensive off anti-hypertensives), (2) improved (normotensive on same or reduced number of medications), or (3) failure (no cure or improvement in number of medications).

Results

The medical histories of 59 children (median age 9.98 years) were reviewed, of whom 20 (44 %) had revascularization procedures. All were hypertensive, with a mean systolic and diastolic blood pressure of 161.5 ± 36 and 106.5 ± 31 mmHg, respectively. RAS was present in 45 (76.3 %) children. Twenty-four revascularization procedures were performed in 20 children (44 %), of whom five had contralateral nephrectomies. Outcome was available for 17 patients at the 3- and 6-months follow-up, with cure, improvement and failure rates at 3 months of 2/17 (11.8 %), 7/17 (41.2 %) and 8/19 (47 %), respectively, and similar rates at 6 months. Associations between outcome and age (p = 0.51), sex (p = 0.32), number of pre-surgery anti-hypertensives (p = 0.18) and stenosis sites (p = 0.22) were not statistically significant.

Conclusions

Revascularization was beneficial to the management of blood pressure control in about half of our RVH patients.

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Acknowledgements

The authors express appreciation to the International Paediatric Nephrology Association for sponsorship of TAL for training in Paediatric Nephrology at the Red Cross Children’s Hospital in Cape Town, South Africa.

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Correspondence to Taiwo Augustina Ladapo.

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Ladapo, T.A., Gajjar, P., McCulloch, M. et al. Impact of revascularization on hypertension in children with Takayasu’s arteritis-induced renal artery stenosis: a 21-year review. Pediatr Nephrol 30, 1289–1295 (2015). https://doi.org/10.1007/s00467-015-3049-y

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  • DOI: https://doi.org/10.1007/s00467-015-3049-y

Keywords

  • Reno-vascular hypertension
  • Takayasu’s arteritis
  • Revascularization
  • Blood pressure
  • Children