Renovascular Hypertension in Children

Kang, Byoung-Chul; Ha, Il-Soo; Kim, In-One; Cheong, Hae-Il; Choi, Yong; Ko, Kwang-Wook

J Korean Soc Pediatr Nephrol > Volume 1(2); 1997 > Article

J Korean Soc Pediatr Nephrol 1997;1(2): 101-108.

소아의 신혈관성 고혈압

강병철, 하일수, 김인원, 정해일, 최용, 고광욱

¹서울대학교 의과대학 소아과학교실
²서울대학교 의과대학 소아과학교실
³서울대학교 의과대학 진단방사선과학교실
⁴서울대학교 의과대학 소아과학교실
⁵서울대학교 의과대학 소아과학교실
⁶서울대학교 의과대학 소아과학교실

Renovascular Hypertension in Children

Byoung-Chul Kang, Il-Soo Ha, In-One Kim, Hae-Il Cheong, Yong Choi, Kwang-Wook Ko

¹Department of Pediatrics, Seoul National University, College of Medicine
²Department of Pediatrics, Seoul National University, College of Medicine
³Department of Diagnostic Radiology, Seoul National University, College of Medicine
⁴Department of Pediatrics, Seoul National University, College of Medicine
⁵Department of Pediatrics, Seoul National University, College of Medicine
⁶Department of Pediatrics, Seoul National University, College of Medicine

ABSTRACT

Purpose : The clinical characteristics of renovascular hypertension (RVHT) in children were analyzed.
Methods : Medical records of 16 children diagnosed as RVHT on the basis of angiography during Jan. '86 to Jun. 94 in our hospital were reviewed retrospectively.
Results : The mean age at the onset was 8.5 yrs and the sex ratio(M:F) was 7:9. The causes of RVHT were Takayasu arteritis in 6, Moyamoya disease in 5, and fibromuscular dysplasia in 3 patients. Abdominal bruit was noted in 6 patients (38%). Peripheral renin activity was raised in all tested patients. Bilateral renal arterial involvemnent was found in 9 patients (56%). Captopril renal scans showed good correlation with angiographic findings. Five patients were treated with antihypertensives only, and blood pressure was controlled completely in 2 and incompletely in 3. Percutaneous transluminal angioplasty was performed in 10 patients with 50% of success rate. However, hypertension was recurred due to restenosis or accompaning aortic stenosis in 3 patients. Surgical treatment was performed in 4 patients, and the blood pressure was controlled partially in 1 and poorly in the remaining 3.
Conclusions : Takayasu arteritis, Moyamoya disease and fibromuscular dysplasia are the major causes of childhood RVHT in our country. The diagnosis of RVHT in children should be based on a set of tests individually selected for case by case. For the low curability of the current treatment modalities available, RVHT in children should not be regarded as 'curable' so far. We expect, however, that the outcome will be improved by more extensive application of the newly developed surgical technique.

Key words: Renovascular hypertension in Children | Takayasu arteritis | Moyamoya disease | Fibromuscular dysplasia