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G60 SINGLE CENTRE OUTCOME OF CHILDHOOD PRIMARY RENOVASCULAR HYPERTENSION
S. D. Marks, R. Davies, M. J. Dillon, P. Duffy, I. Gordon, G. Hamilton, R. HLord, C. McLaren, D. Roebuck, V. Shah, R. Shroff, S. E. Stephen, K. Tullus.Great Ormond Street Hospital for Children NHS Trust, London, UK
Aims: To evaluate the clinical outcomes, morbidity, and mortality of children undergoing medical and surgical interventions in renovascular hypertension in a tertiary and quaternary paediatric nephrology service over the past 30 years.
Methods: Patients were identified through searches of the Paediatric Nephrology database at Great Ormond Street Hospital for Children. Exclusion criteria included hypertension secondary to vasculitis (such as polyarteritis nodosa) and transplant renal artery stenosis.
Results: Full data were available for a total of 109 patients (70 male (64%)) who presented at aged 0.5–17.0 (median 7.7) years with renovascular hypertension. Twenty three (21%) patients were asymptomatic with hypertension noted as an incidental finding and 27 (25%) diagnosed secondary to a hypertension associated syndrome (namely neurofibromatosis type 1, Williams, and velo-cardial facial syndromes). Systolic blood pressure at presentation was 120–270 (median 167) mm Hg. Patients required between two and nine (median 4) antihypertensive agents. There was evidence of end organ damage with 73 (67%) patients with left ventricular hypertrophy, 36 (33%) with hypertensive retinopathy, and 40 (37%) with proteinuria. The estimated glomerular filtration rate was 67–122 (median 108) mls/min/1.73 m2. Medical management was undertaken in all patients by consultant paediatric nephrologists. Forty six (42%) children underwent 73 interventional radiological and/or surgical procedures for treatment of hypertension, including transluminal angioplasty (in 33), nephrectomy (in 17), and revascularisation and autotransplantation procedures (in 23) by interventional radiologist, urologists, and transplant and vascular surgeons. Twenty three (50%) patients were deemed to be cured as they were normotensive off all antihypertensives after therapeutic interventions. This was possible in 47% of nephrectomies, 27% of angioplasties, …