Renal artery branch stenosis induced hypertension in children: a case series.

Abstract

Purpose: Renal artery branch stenosis induced hypertension (HTN) in children is rare and facing a great challenge in diagnosis and treatment. This study aimed to summarize the clinical features and experience in diagnosis and treatment of these children.

Methods: Four children diagnosed with renal artery branch stenosis induced HTN in the Cardiovascular Department of Children's Hospital, Capital Institute of Pediatrics were retrospectively summarized with the clinical data, the process of diagnosis and treatment, and the prognosis.

Results: All patients were male with the age of 8 ~ 9 years. All were diagnosed with stage 2 HTN and most had significant symptoms. Routine examinations showed no abnormalities. A slight perfusion defect in the kidney was observed on abdominal contrast-enhanced computed tomography (CECT) in all cases. Renal artery branch stenosis was clearly detected by selective renal artery angiography. One had stenosis in the interlobular artery of the kidney, and the remaining had secondary branches stenosis. In terms of treatment, two children underwent selective renal artery embolization (SRAE), one underwent dilation by microcatheter, and the other one did not undergo interventional therapy due to arterial segmental narrowing. More than one year after SRAE, the number of antihypertensive medications was cut down with the blood pressure (BP) level reduced to normal.

Conclusion: Renal artery branch stenosis should be considered in younger children with early onset of HTN and significantly elevated BP. Selective renal artery angiography is the gold standard for diagnosis. However, the treatment is challenging, and SRAE may be a better choice in some cases.