Case report: secondary hypertension in a 6-year old child with bilateral renal artery stenosis
https://doi.org/10.15690/rpj.v1i2.2093
Abstract
Background. Renovascular hypertension (RVH) is an elevated blood pressure caused by partial or complete occlusion of one or both renal arteries or their branches. According to different studies, renal artery stenosis accounts for 5–10% of all cases of hypertension in children. The most common causes of renal artery stenosis are deemed to be atherosclerosis and fibromuscular dysplasia.
Case description. The article describes clinical case of a newly diagnosed renovascular hypertension amid background of fibromuscular dysplasia of renal arteries in a 6-year old child, particulars of the clinical course, laboratory and instrumental methods of investigation and treatment including aortography and balloon angioplasty of renal arteries.
Conclusion. This case report illustrates that in the absence of complaints and pronounced clinical symptoms the diagnosis of renovascular hypertension in a 6-year old child could not be established for a long time. Timely detection of elevated BP in children, including the young ones, not only during visiting specialist physicians but also during prophylactic examination by pediatrician, is required for early diagnosis of the disease and development of the examination and treatment strategy.
About the Authors
Tatyana A. Ryazanova
Federal State Budget Educational Institution of Higher Education «Ural State Medical University» of the Ministry of Health of Russia
Russian Federation
Ekaterinburg
Russian Federation
Ekaterinburg
Yuliya A. Trunova
Federal State Budget Educational Institution of Higher Education «Ural State Medical University» of the Ministry of Health of Russia
Russian Federation
Ekaterinburg
Russian Federation
Ekaterinburg
Anastasia S. Arkhipova
Federal State Budget Educational Institution of Higher Education «Ural State Medical University» of the Ministry of Health of Russia
Russian Federation
Ekaterinburg
Russian Federation
Ekaterinburg
References
1. Kallistratos MS, Giannakopoulos A, German V, et al. Diagnostic modalities of the most common forms of secondary hypertension. Hellenic J Cardiol. 2010;51(6):518–529.
2. Razumovskij A. Yu., Alhasov A. B., Bataev S. M., Abdurazakov M. A. Hirurgicheskoe lechenie vazorenal’noj gipertenzii u detej. Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. 2018;8(1):36–43. (In Russ).
3. Viera A.J., Neutze D. M. Diagnosis of secondary hypertension: an agebased approach. Am Fam Physician. 2010;82(12):1471–1478.
4. Schneider D.B., Stanley J. C., Messina L. M. Renal artery fibrodysplasia and renovascular hypertension. Vascular Surg. 2005;(8):1789–1804.
5. Lao D., Parasher P. S., Cho K. C., et al. Atherosclerotic renal artery stenosis — diagnosis and treatment. Mayo Clin Proc. 2011;86(7):649–657. doi: 10.4065/mcp.2011.0181.
6. Albot V.V., Dolgikh V. V., Gvak G. V., Pogodina A. V. Fibromuscular dysplasia as the cause of malignant renovascular hypertension in a newborn. Systemic Hypertension. 2015;12(2):29–32. doi: 10.26442/2075-082x_12.2.29-32.
7. Chigidinova D. C., Gavrilova N. E., Rudenko B. A., et al. Еndovaskuljarnoe lechenie stenoza pochechnoj arterii, vyzvannogo fibromuskuljarnoj displaziej. Klinicheskij sluchaj. Kreativnaja hirurgija i onkologija. 2019;9(3):223–228. (In Russ).
8. Plouin PF, Baguet JP, Thony F, et al. High prevalence of multiple arterial bed lesions in patients with fibromuscular dysplasia: The ARCADIA Registry (Assessment of Renal and Cervical Artery Dysplasia). Hypertension. 2017;70(3):652–658. doi: 10.1161/hypertensionaha.117.09539.
9. Tullus K. Vascular hypertension in children. 3rd ed. Flynn J, Ingelfinger J, Portman R et al. (eds.). Pediatric Hypertension. Clinical Hypertension and Vascular Diseases. Totowa (NJ): Springer Science+Business Media New York; 2013. doi: 10.1007/978-1-62703-490-6_24.
10. Savenkova N. D. Nefrogennaja arterial’naja gipertenzija u detej i podrostkov: prichiny, klassifikacija, diagnostika. Rossijskij vestnik perinatologii i pediatrii. 2017;62(4):43–48. (In Russ).
11. ПPerekal’skaja M.A., Volkova I. I., Ostanina Yu.O., Luksha E. B. Sosudistaja patologija pri nasleduemyh narushenijah soedinitel’noj tkani. Rossijskij kardiologicheskij zhurnal. 2013;2(100):83–88. (In Russ).
12. Arhipova N. N. Vtorichnye arterial'nye gipertenzii u detej. Prakticheskaja medicina. 2011;(5):20–24. (In Russ).
13. Persu A., Van der Niepen P., Touze E., et al. Revisiting fibromuscular dysplasia: rationale of the european fibromuscular dysplasia initiative. Hypertension. 2016;68(4):832–839. doi: 10.1161/hypertensionaha.116.07543.
14. Slovut D.P., Olin J. W. Fibromuscular dysplasia. N Engl J Med. 2004;350(18):1862–1871. doi: 10.1056/nejmra032393.
15. O’Connor S.C., Poria N., Gornik H. L. Fibromuscular dysplasia: an update for the headache clinician. Headache: The Journal of Head and Face Pain. 2015;55(5):748–755. doi: 10.1111/head.12560.
16. Olin JW, Froehlich J, Ziaokui G. The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients. Vascular Surgery. 2012;56(5):1474. doi: 10.1016/j.jvs.2012.09.033.
17. Tullus K. Renal artery stenosis: is angiography still the gold standard in 2011. Pediatr Nephrol. 2011;26(6):833–837. doi: 10.1007/s00467-010-1757-x.
18. Gasymov Е. G., Abdulgasanov R. A. Fibroznomyshechnaja displazija pochechnyh arterij (sovremennye metody diagnostiki i lechenija). Kreativnaja kardiologija. 2018;12(1):62–69. (In Russ).
19. Bolen M.A., Brinza E., Renapurkar R. D., et al. Screening CT angiography of the aorta, visceral branch vessels, and pelvic arteries in fibromuscular dysplasia. JACC Cardiovascular Imaging. 2017;10(5):554–561. doi: 10.1016/j.jcmg.2016.04.010.
20. Smith A., Gaba R. C., Bui J. T., et al. Management of renovascular hypertension. Tech Vasc Interv Radiol. 2016;19(3):211–217. doi: 10.1053/j.tvir.2016.06.006.
21. Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763–816.
22. Iwashima Y, Fukuda T, Yoshihara F, et al. Incidence and risk factors for restenosis, and its impact on blood pressure control after percutaneous transluminal renal angioplasty in hypertensive patients with renal artery stenosis. J Hypertens. 2016;34(7): 1407–1415. doi:10.1097/hjh.0000000000000928.
Review
For citations:
Ryazanova T.A., Trunova Yu.A., Arkhipova A.S. Case report: secondary hypertension in a 6-year old child with bilateral renal artery stenosis. Russian Pediatric Journal. 2020;1(2):45-50. (In Russ.) https://doi.org/10.15690/rpj.v1i2.2093
Views:
4899
Email this article 
