Renovascular hypertension in an 8-year-old girl

Abstract

Secondary hypertension is the most common form of hypertension in childhood, particularly in the young age group: parenchymal disease and lesions of the renal artery account for the majority of such cases. Renal artery aneurysms (RAA) are rare and are usually diagnosed by Doppler ultrasonography or angiography performed in the investigation of specific clinical symptoms. We report herein a case of severe arterial hypertension in an 8-year-old girl arising from a large saccular RAA. Intravenous antihypertensive drugs were necessary to achieve blood pressure control and the final diagnosis was obtained from angio-CT scan and selective angiography that demonstrated a large saccular aneurysm of the left renal artery with parietal calcification. After confirmation of inexistent function of the entire left kidney by Tc99m-MAG3 renal isotope scan, nephrectomy was performed. The child's blood pressure further normalised and, 1 month after surgery, she had ceased any antihypertensive therapy.

Figure 1

Renal sonogram showing an aneurysm of the left renal artery measuring 32×19.8 mm.

Figure 2

Angio-CT scan (horizontal plane): large saccular aneurysm of the left renal artery measuring 20×21×24 mm with parietal calcification.

Figure 3

Angio-CT scan (coronal plane): large saccular aneurysm of the left renal artery measuring 20×21×24 mm with parietal calcification.

Figure 4

Three-dimensional angio-CT scan: large saccular aneurysm of the left renal artery with parietal calcification.

Figure 5

Selective angiography revealing aneurysm of the left renal artery.

Figure 6

Tc99m-MAG3 renal isotope scan: functional right kidney with inexistent function of the entire left kidney.