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Renovascular hypertension in pediatric patients: update on diagnosis and management

Abstract

Renovascular hypertension (RVH) is defined as an elevated blood pressure caused by kidney hypoperfusion, generally as a result of anatomic stenosis of the renal artery with consequent activation of the Renin Angiotensin-Aldosterone System. The main causes include genetic and inflammatory disorders, extrinsic compression, and idiopathic alterations. RVH is often asymptomatic and should be suspected in any child with refractory hypertension, especially if other suggestive findings are present, including those with severe hypertension, abdominal bruit, and abrupt fall of glomerular filtration rate after administration of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. There is a consensus that digital subtraction angiography is the gold standard method for the diagnosis of RVH. Nevertheless, the role of non-invasive imaging studies such as Doppler ultrasound, magnetic resonance angiography, or computed tomographic angiography remains controversial, especially due to limited pediatric evidence. The therapeutic approach should be individualized, and management options include non-surgical pharmacological therapy and revascularization with percutaneous transluminal renal angioplasty (PTRA) or surgery. The prognosis is related to the procedure performed, and PTRA has a higher restenosis rate compared to surgery, although a decreased risk of complications. This review summarizes the causes, physiopathology, diagnosis, treatment, and prognosis of RVH in pediatric patients. Further studies are required to define the best approach for RVH in children.

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Funding

This work was partially supported by Brazilian National Council of Research Development (CNPq - Grant # 302153/2019-5), Coordination of High Education Level Personnel (CAPES) and Foundation of Research of Minas Gerais (FAPEMIG).

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JLOC, LB, ALP, DFS, FJJL and LTOD made the literature revision and selection of main articles, defined the topics of this review and wrote the first draft. ACSS conceptualized the study, made general supervision and revised the manuscript. ACSS submitted the final version of the manuscript, which is approved by all authors.

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Correspondence to Ana Cristina Simões e Silva.

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1. d; 2. a; 3. c; 4. b

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de Oliveira Campos, J.L., Bitencourt, L., Pedrosa, A.L. et al. Renovascular hypertension in pediatric patients: update on diagnosis and management. Pediatr Nephrol 36, 3853–3868 (2020). https://doi.org/10.1007/s00467-021-05063-2

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Keywords

  • Renovascular hypertension
  • Fibromuscular dysplasia
  • Renin Angiotensin-Aldosterone System
  • Digital subtraction angiography
  • Percutaneous transluminal renal angioplasty