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Angioplasty for renovascular hypertension in 78 children
  1. Jameela A Kari1,2,
  2. Derek J Roebuck3,
  3. Clare A McLaren3,
  4. Meryl Davis2,
  5. Michael J Dillon2,
  6. George Hamilton2,
  7. Rukshana Shroff2,
  8. Stephen D Marks2,
  9. Kjell Tullus2
  1. 1Department of Paediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
  2. 2Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
  3. 3Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
  1. Correspondence to Dr Kjell Tullus, Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, England, UK; Kjell.Tullus{at}gosh.nhs.uk

Abstract

Objectives To evaluate the outcome of percutaneous transluminal angioplasty (PTA) in children with renovascular hypertension (RVH) treated at a single centre over 29 years.

Methods A retrospective study of the medical charts of all children with RVH who underwent PTA between 1984 and 2012. The primary outcome measurement was blood pressure (BP) achieved after the procedure. The BP before the procedure was compared with that at last available follow-up, 6 (range 0.6–16) years after the initial procedure.

Results Seventy-eight children with median (range) age of 6.5 (0.5–17) years were studied. Twenty-three (29.5%) had an underlying syndrome, 35 (44.9%) children had bilateral renal artery stenosis (RAS), 18 (23%) intrarenal disease and 11(14%) showed bilateral RAS and intrarenal disease. Twenty (25.6%) children had mid-aortic syndrome and 14 (17.9%) cerebrovascular disease. One hundred and fourteen PTA procedures were carried out including 31 stent insertions. Following PTA, BP was improved in 49 (62.8%) children and of those 18 (23.1%) were cured. Children with involvement of only the main renal arteries showed improved BP control in 79.9% of the children with cure in 39.5%. BP was intentionally maintained above the 95th centile for age and height in four children with coexistent cerebrovascular disease. No change in BP was seen in 18 children despite observed technical success of the PTA, and in seven children due to technical failure of the procedure.

Conclusions PTA provided a clinical benefit in 62.8% of children with RVH.

  • Nephrology
  • Imaging

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