ESPN 50th Annual Meeting

ESPN 2017


 
Outcomes of combined medical and surgical treatment for pediatric renovascular hypertension
Marina Shumikhina 1 Aleksandr Razumovskiy 1 Olga Chugunova 2 Anzhelika Gurevich 1 Abdumanap Alkhasov 1 Nadezhda Kulikova 1 Aleksandr Zadvernyuk 1 Nikita Stepanenko 1 Natalia Korchagina 1

1- FILATOV CHILDREN’S CLINICAL HOSPITAL №13, MOSCOW, RUSSIA
2- PIROGOV RUSSIAN NATIONAL RESEARCH MEDICAL UNIVERSITY, MOSCOW, RUSSIA
 
Introduction:

Renovascular disease is an uncommon, but important cause of hypertension in children. In the case of resistant hypertension (failure of medical therapy despite full dose of ≥ 3 drugs including diuretic), surgical techniques can improve control of blood pressure (BP).

Material and methods:

This is a retrospective review of patients who underwent combined medical and surgical in our clinic for renovascular hypertension (RVH) between 1999 and 2016.

Results:

A total of 9 children (7 boys, 3 months-14 years, median age 5.5 years) were underwent the complex of clinical, laboratory and instrumental investigations. All of them had normal glomerular filtration rate, different degree of microalbuminuria (30 mg/g>microalbumin/creatinine<150 mg/g) and second organ damage (heart – 5/9, kidneys -6/9 and eyes – 6/9). The BP level was above the 95th centile for age and height in all children (up to 180/120 mmHg). In clinic everyone were treated for resistant hypertension by different combined therapy. Seven children had renal artery stenosis (3 – unilateral, 4 - bilateral), 1 - had mid-aortic syndrome, 1 – had aneurysm of renal arterial. There was no children with vasculitis or Takayasu arteritis. The angiography was performed in all children, with separate detection of plasma renin activity in renal veins (in all children it was extremely high – 10-20 normative values, in the case of bilateral lesion – it was more than in 1.5 times higher than in the side of stenosis), also 3/9 patient – had underwent to the percutaneous transluminal renal angioplasty during angiography, but it was unsuccessful. All patients received renovascular surgery on the renal arteries: 4 – unilateral, 2 - bilateral autologous surgery, 1 – reimplantation of renal artery and 1 - aortic reconstruction with a synthetic graft. One 3 y.o. boy with bilateral stenosis had undergo autologous surgery only in one side, because of severe total condition. Fibromuscular dysplasia was the most common morphological diagnosis (6/9). Post-operative complications were hemorrhage (1/9), that indicated repeated surgery (without nephrectomy) and 1/9 had failed hemodynamics, which required resuscitation (was successful). There were no peri- or postoperative deaths. BP was improved in all 9 children and of those 5 (4 - with unilateral, 1 – with bilateral RAS) were cured (havent antyhypertensive therapy in a 1-year after the operation).

Conclusions:

All children are needed to measurement the BP, because moderate or even severe elevated blood pressure (for example, as a result of RVH) often is unspecific or have no symptoms. If the case of RVH - medical treatment must undergo immediately, but if it is not enough - surgery should not be delayed. In our exclusively pediatric population angioplasty safely improved blood pressure control in all of patients, more than half of which are cured.