Pediatric renovascular hypertension: Treatment outcome according to underlying disease

• Published in: Pediatrics international 2018-03, Vol.60 (3), p.264-269
• Main Authors: Lee, Yeonhee, Lim, Young Shin, Lee, Sang Taek, Cho, Heeyeon
• Format: Article
• Language: English
• Subjects: Adolescent; Angiography; Angioplasty; Angioplasty - methods; Antihypertensive Agents - therapeutic use; Antihypertensives; Blood Pressure; Brain injury; Child; Child, Preschool; Children; Combined treatment; Damage prevention; Female; Humans; Hypertension; Hypertension, Renovascular - etiology; Hypertension, Renovascular - therapy; Lesions; Male; Medical records; Medical treatment; Moyamoya disease; Nephrectomy; Nephrectomy - methods; Organs; Patients; Pediatrics; renovascular hypertension; Republic of Korea; Restenosis; Retina; Retrospective Studies; Surgery; Treatment Outcome
• ISSN: 1328-8067; 1442-200X
• DOI: 10.1111/ped.13491

Background Renovascular hypertension (RVH) accounts for 5–10% of pediatric hypertension, and can be associated with underlying disease involving other organs. The purpose of this study was to evaluate the clinical characteristics and assess the treatment outcomes of Korean pediatric patients with RVH. Methods The medical records of 25 Korean pediatric patients with RVH were retrospectively reviewed. Results Twenty‐four patients had underlying disease, and the most common cause was moyamoya disease (MMD; n = 10; 40%). Of 10 patients with MMD, seven had RVH prior to MMD. All patients required antihypertensive medication as the initial treatment and 22 patients subsequently underwent percutaneous transluminal angioplasty (PTA). The majority of patients with MMD had ostial lesions on angiography. Eight patients had favorable outcomes after the first PTA. One patient received nephrectomy, and two patients received bypass surgery because of restenosis after PTA and technical failure of PTA, respectively. During follow up, blood pressure was well‐controlled in nine patients, but only four patients were able to discontinue medication. Eight patients had target‐organ damage of the brain, heart, and retina at the time of initial diagnosis, and five patients developed chronic kidney disease during follow up. Conclusion The most common cause of RVH in Korean children is MMD, and RVH caused by MMD with an ostial lesion is associated with poor PTA outcomes. Angioplasty alone does not appear to control blood pressure effectively in MMD patients, and combined treatment is necessary to prevent target organ damage.