Surgical treatment of renal hypertension in children

Renal autotransplantation in children: a successful treatment for renovascular hypertension

Renovascular hypertension in children is not a common disease. With improved surgical technique the incidence of nephrectomy has decreased and renovascular reconstruction is currently the preferred method to manage this entity. Between 1977 and 1988, 21 patients with renovascular hypertension were treated at our hospital: 7 patients 6 to 16 years old underwent renal autotransplantation. Of the children 4 had unilateral and 3 had bilateral disease requiring bilateral autotransplantation. Autotransplantation was performed by anastomosis of each renal artery end-to-side to the common iliac artery. The renal veins were anastomosed end-to-side to the common iliac veins. The ureters were left intact in all but 1 patient who required a bench operation. Of the 4 patients who had a unilateral procedure 3 are cured and 1 is improved with a normal blood pressure on a small dose of antihypertensive medication. The 3 patients with bilateral autotransplants are cured. These results, with normalization of the blood pressure in 86% of the patients and improvement in blood pressure in 14% with a patency rate of 87%, are similar to other reported reconstructive modalities in children.

Long-term follow-up of surgical renal hypertension

A retrospective study of 42 children with hypertension secondary to renal disease is presented. Thirty-three had scarred kidneys, 5 had renovascular disease, 2 had renal venous thrombosis, 1 had an angiomatous malformation of the upper pole of the kidney, and 1 had glomerulonephritis. Twenty-six children were managed surgically. The etiology, presentation, and management are presented. Follow-up varied from 2 to 14 years and the outcome is discussed.

Renal vein renin measurement and arteriography in the investigation and management of severe childhood hypertension

Forty-two children aged one to sixteen years with persistent and severe hypertension were investigated by renal vein renin measurements. There were no serious complications in the 49 procedures performed and technical failure occurred on three occasions. Arteriography was performed in 35. Asymmetrical renin release was found in 22 patients and of these 15 underwent surgery. This was successful in 12 patients (80%) who became normotensive. Ten had unilateral disease (100% cure rate) but only 2 (40%) with bilateral disease became normotensive. Renal vein renin studies combined with arteriography have a useful role in the investigation and management of childhood hypertension.

Surgical treatment of renovascular hypertension in children: the roile of renal autotransplantation

We describe 2 children with renovascular hypertension treated successfully by autotransplantation, as well as an additional child in whom ex vivo microsurgical repair was attempted. The literature is reviewed and all patients within the pediatric age group with renovascular hypertension who were treated surgically are reported. The different types of vascular reconstructive techniques and, particularly, the previous use of autotransplantation are discussed.