Renovascular hypertension in children

Renal artery stenosis in infants: long-term medical treatment before surgery

This report describes five infants (3 male, 2 female) with renal artery stenosis diagnosed in their 1st year of life. The age at initial presentation was 5 days to 10 months. All had symptoms of congestive heart failure, cardiomegaly on chest X-ray, and left ventricular hypertrophy by electrocardiogram or echocardiogram. Renograms were abnormal in four of the five infants. An intravenous pyelogram was obtained in three infants and was abnormal in two. Renal ultrasounds were obtained in two infants and were normal in both. Patients were treated for 4.4 +/- 0.9 years with antihypertensive drug therapy until surgical correction of the renal artery stenosis. Blood pressure was persistently elevated above the 95th percentile in four of the infants during the course of antihypertensive therapy prior to surgery. Patients have been followed for 9.4 +/- 2 years since surgery. The blood pressure of four patients is normal, and the blood pressure of the oldest patient (age 23 years) is borderline hypertensive. These data show that infants with renal artery stenosis can be cared for successfully with long-term antihypertensive drug therapy to preserve renal mass with minimal chronic adverse effects.

Concomitant carotid, mesenteric and renal artery stenosis due to primary intimal fibroplasia

We report 2 cases of primary intimal fibroplasia involving the carotid, mesenteric and renal arteries. These patients presented with hypertension and neurological symptoms. Clinical and histologic features of neurofibromatosis or Takayasu's arteritis were absent. In both cases successful staged carotid and renovascular reconstruction was performed. Primary intimal fibroplasia may be a more generalized process than has been considered previously.

Renin-dependent renovascular hypertension in infant with abdominal aortic atresia

A newborn infant was seen with severe and progressive arterial hypertension, congenital atresia of the abdominal aorta, and a renal venous renin activity ratio greater that 1:1.5 (1:3.1). Preoperative studies indicated that the renin-angiotensin axis was responsible for the production and maintenance of the severe hypertensive process. Right nephrectomy cured the arterial hypertension both above and below the area of coarctation. The possible roles of the pathogenic mechanism are discussed.