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Journal of the Korean Society of Pediatric Nephrology 2010;14(2): 223-229. doi: https://doi.org/10.3339/jkspn.2010.14.2.223
신 자가이식을 통한 14세 소년에서 발생한 심한 신성 고혈압의 성공적인 치료
지민철, 박세진, 최재영, 고영국, 김명수, 김지홍, 신재일
1연세대학교 의과대학 세브란스 어린이병원 소아청소년과 신장질환 연구소
2연세대학교 의과대학 세브란스 어린이병원 소아청소년과 신장질환 연구소
3연세대학교 의과대학 소아심장과
4연세대학교 의과대학 내과학교실
5연세대학교 의과대학 외과학 교실, 장기이식 연구소
6연세대학교 의과대학 세브란스 어린이병원 소아청소년과 신장질환 연구소
7연세대학교 의과대학 세브란스 어린이병원 소아청소년과 신장질환 연구소
Successful Renal Autotransplantation for the Treatment of Severe Renovascular Hypertension in a 14-year-old Boy
Min-Chul Ji, Se-Jin Park, Jae-Young Choi, Young-Guk Ko, Myoung-Soo Kim, Ji-Hong Kim, Jae-Il Shin
1The Institute of Kidney Disease, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine
2The Institute of Kidney Disease, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine
3Department of Pediatric Cardiology, Yonsei University College of Medicine
4Department of Internal Medicine, Yonsei University College of Medicine
5Department of Surgery and The Research Institute for Transplantation, Yonsei University College of Medicine
6The Institute of Kidney Disease, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine
7The Institute of Kidney Disease, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine
Received: September 17, 2010;  Revised: September 20, 2010.  Accepted: September 28, 2010.
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ABSTRACT
Percutaneous transluminal renal angioplasty (PTRA) is the current treatment of choice for renal artery revascularization, but renal autotransplantation has been an alternative treatment for complex cases. Here we report a 14-year-old boy with severe hypertension successfully treated with PTRA and renal autotransplantation. Doppler ultrasonography and computed tomography (CT) angiography revealed slight narrowing in the right renal artery ostium and complete obstruction in the left renal artery ostium with multiple collaterals. PTRA with stent insertion was performed for the treatment of the right renal artery, but it was impossible for the left renal artery due to the total obstruction. Therefore, left nephrectomy for autotransplantation was done with the peritoneal approach and the left kidney was autotransplanted to the ipsilateral iliac fossa. Postoperatively, Doppler ultrasonography and mercapto-acetyl-triglycine (MAG-3) renogram were performed, which showed normal renal artery blood flow and kidney function. Blood pressure was normalized and anti-hypertensive drugs were gradually tapered. Fibromuscular dysplasia was suspected to be responsible for the renal artery stenosis based on clinical aspects. In conclusion, renal autotransplantation is also a good treatment option for children with severe renovascular hypertension when endovascular treatment has failed or is not possible.
Key words: Renovascular | hypertension | percutaneous transluminal renal angioplasty | renal autotransplantation | Children
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Renal and Renovascular Hypertension in Children  2011 April;15(1)
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