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2023, Number 3

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Acta Pediatr Mex 2023; 44 (3)

Renovascular arterial hypertension in children. Three case report

Gahona-Villegas JR, Reyes-Jurado P, Ríos-Méndez RE

Language: Spanish
References: 10
Page: 204-209
PDF size: 269.95 Kb.


ABSTRACT

Introduction: Renovascular hypertension (HTN) is an infrequent disease in children caused by compromised renal blood flow due to artery obstruction. Confirmation of the diagnosis is made by digital subtraction angiography. HTN must be controlled with antihypertensive therapy. Definite treatment is by percutaneous angioplasty with a balloon or stent.
Clinical cases: Three cases of children of 1, 5 and 10 years of age with HTN who underwent non-invasive laboratory and imaging studies with inconclusive results are presented. Given the high suspicion of renal stenosis, renal catheterization angiography was performed, evidencing stenosis of the main renal artery or its branches. Balloon angioplasty was performed in the same act in all 3 cases. It was possible to reduce and maintain blood pressure below p‹95 without medication in two of the cases. Follow-up was in 3 years, only one maintains antihypertensive medication; requires new balloon dilation and stent placement.
Conclusions: In this case-series, non-invasive imaging methods were inconclusive, reporting only renal asymmetry. Elevated levels of renin, aldosterone, and mixed alkalosis generate high suspicion for the diagnosis. Treatment with ACE inhibitors and ARA II had no impact on renal function and could be considered first line treatment under constant monitoring. Angiography by catheterization was diagnostic and therapeutic in the same act.


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