Diagnostic and medical strategy for renovascular hypertension: report from a monocentric pediatric cohort

Renovascular hypertension accounts for 5-10 % of hypertensioncases in children; there is currently noconsensus on treatment. Here, we report on our clinical experience with this disease and outline the different pathways in which to investigate it. We report retrospectively on ten children diag- nosed with renovascular hypertension at the University Hos- pital of Nantes from 2001 to 2012. The main findings were obtained by fortuitous screening of children aged 2 months to 14 years old with neurofibromatosis (n=2) and fibromuscular dysplasia (n=8). The hypertension was always severe yet asymptomatic. Lesions were complicated in nine out of ten cases and included bilateral, multiple, mid-aortic syndrome and aneurysm. Doppler ultrasound associated with computed tomographyallowedfor aprecisediagnosisinsevenout often cases. Where ambiguities persisted, they were highlighted by arteriography, the gold standard investigation. Medical treatment was insufficient, leading to invasive procedures in nine out of ten children: 2 nephrectomies, 2 autotransplantations, and 21 repetitive percutaneous translu- minal angioplasties.After invasiveprocedures,blood pressure control improved in four cases and was resolved in three. Conclusion: Arteriography remains to be the gold standard technique for renovascular hypertension in children and can be combined with angioplasty when medical treat- ment is rendered obsolete. The role of computed tomog- raphy is controversial. Despite the heterogeneity of the children studied, we present a general medical and ther- apeutic management pathway for the treatment of this disease.