ESPN 51th Annual Meeting

ESPN 2018


 
SEVERE RENAL ARTERY STENOSIS MAY NOT DETECTED VIA DOPPLER ULTRASONOGRAPHY IN CHILDREN
GUNES ISIK 1 DENIZ ERDOGAN 2 EMRE OZTURK 2 SUKRU OGUZ 3 HASAN DINC 3 ELIF BAHAT OZDOGAN 1

1- KARADENIZ TECHNICAL UNIVERSITY FACULTY OF MEDICINE PEDIATRIC NEPHROLOGY DEPARTMENT
2- KARADENIZ TECHNICAL UNIVERSITY FACULTY OF MEDICINE, DEPARTMENT OF PEDIATRICS
3- KARADENIZ TECHNICAL UNIVERSITY FACULTY OF MEDICINE,INTERVENTIONAL RADIOLOGY DEPARTMENT
 
Introduction:

 

Renal artery stenosis (RAS) is an important cause of hypertension in adults (5 %)  and children (10 %). Fibromuscular dysplasia, genetic syndromes (neurofibromatosis 1, tuberous sclerosis, and middle aortic syndrome), vasculitis  are the underlying causes.

Material and methods:

 

A 11-year-old boy presented with intermittent headache and fatigue during the last 1 year. Blood pressure was  170/120 mmHg. Five anti-hypertensive drugs included intravenosis beta bloker infusion were used on maximume doses. Systemic vasculitis findings were not detected. Urinary  and  renal arterial doppler ultrasonography  were normal ranges. Abdominal diffusion magnetic resonance imaging(MR) suspected  left hypoplastic kidney. Contrast enhanced MR renal angioraphy was performed; severe stenosis in proximal part of  left renal artery and moderate stenosis originating from celiac truncus. He underwent  percutaneous transluminal renal angioplasty (PTRA). Severe stenosis(2.5 cm) was observed in the  renal artery origin. PRTA was applied via 2 mm and 2.5 mm balloon catheters. Because of the vasculer endotelial dissection with PRTA, 2 stents were opened in this region. Superficial tissue US was appilied  for the inguinal pain two days later and ​​pseudoaneurysm was seen. The blood pressure started to decline gradually  and antihypertensive medications were reduced after one month.

Results:

 

Angiography remains the gold standard for diagnosis of RAS. Anti-hypertensive medical therapy is usually not enough for controlling hypertension. Surgical revascularization is an effective therapy. Balloon angioplasty is sometimes insufficient to overcome the stenosis and stent angioplasty is necessary such as our patient.  After balloon and stent angioplasty, complications maybe ocur like pseudoaneurysm.

Conclusions:

 

 Renal artery stenosis should be kept in mind in patients with unexplained and uncontrolled hypertension.  Renal doppler ultrasonography findings can sometimes be misleading due to technical problems such as an adequate breath-holding in the children. It is necessary to perform advanced imaging on a severe hypertension that does not respond to treatment. Surgical and percutaneous treatment is often recommended for patients who does not respond to drugs.