Pediatric renal artery occlusive disease and renovascular hypertension. Etiology, diagnosis, and operative treatment

Abstract

Forty pediatric patients (16 girls and 24 boys) 22 months to 17 years old underwent operation for renovascular hypertension. Ostial stenoses were present in 20 children; midrenal lesions were present in eight; and isolated segmental disease was present in 12 patients and was combined with main renal artery stenoses in three patients. Neurofibromatosis affected ten patients, including three having abdominal aortic anomalies. Abdominal aortic coarctation affected five other children. Hypertensive urograms were abnormal only 27% of the time. Renin assays were helpful in identifying functionally important renal ischemia. Fifty-one primary surgical procedures were undertaken, including one simultaneous and nine staged operations for bilateral disease. There were two primary nephrectomies. Six patients underwent later secondary operations. Thirty-four patient (85%) were cured of hypertension, the conditions of five (12.5%) were improved, and one (2.5%) was classified a therapeutic failure. Carefully performed arterial reconstructive surgery will benefit most pediatric patients with renovascular hypertension.