ESPN 51th Annual Meeting

ESPN 2018


 
RENAL ARTERY STENOSIS AS A CAUSE OF PERSISTENT HYPERTENSION IN CHILDREN AND ADOLESCENTS: FIVE CASE REPORTS
IBRAHIM GOKCE 1 MEHTAP SAK 1 NESLIHAN CICEK 1 NURDAN YILDIZ 1 FEYYAZ BALTACIOGLU 2 HARIKA ALPAY 1

1- MARMARA UNIVERSITY MEDICAL SCHOOL DEPARTMENT OF PEDIATRIC NEPHROLOGY
2- MARMARA UNIVERSITY MEDICAL SCHOOL DEPARTMENT OF RADIOLOGY
 
Introduction:

Renovascular hypertension (RVH) is one of the most important causes of secondary hypertension in children and renal artery stenosis (RAS) constitute a significant proportion of renovascular diseases. Here, we report 5 patients presenting with hypertension and diagnosed as RAS.

Material and methods:

 CASE REPORTS

Results:

Patients with RAS were 11, 3, 16, 8, 16 years old respectively. They admitted to hospital with headache, vomiting, consciousness, diplopia, dizziness or unilateral weakness. Blood pressures were  between 145/100 mmHg and 200/145 mmHg, all measures were above the 99.th percentiles for age, gender and height. Renal function tests, autoantibodies, C3, C4, acute phase reactants were all normal. After excluding other reasons of hypertension, we detected bilateral RAS at three patients and unilateral RAS at two patients by computed tomography and selective renal anjiography. Two patients were diagnosed as fibromuscular dysplasia, other patients were diagnosed as Takayasu arteritis, Moyamoya disease and congenital vasculer abnormality. Hypertension was controlled with oral antihypertensive drugs in two patients. Three patients whose blood pressure could not be controlled with multiple antihypertensive drugs underwent balloon angioplasty. Two of the patients with balloon angioplasty did not need further medical treatment,  revascularization failed for the third patient and this patient was referred to a transplant centre for renal autotransplantation.

Conclusions:

Renal artery stenosis should be kept in mind in patients with severe hypertension that do not respond to multiple antihypertensive drugs. Radiological examinations and  presence of systemic involvement is important for differential diagnoses.