Background
Renal artery stenosis (RAS) is an uncommon cause of pediatric hypertension. Guidelines
for workup and management have not been established. The most widely reported etiology
of the pediatric renovascular disease has been fibromuscular dysplasia; however, other
etiologies including middle aortic syndrome (MAS) and vasculitides have been described.
We reviewed cases of radiologically identified pediatric RAS and describe etiologies,
management, and long-term clinical outcomes in our patients.
Methods
Reports for duplex ultrasound, computed tomography angiography, magnetic resonance
imaging, and conventional angiography from an academic children's hospital between
2000 and 2019 were evaluated. Positive reports for RAS were confirmed by a vascular
surgeon and a radiologist. Demographics, indications for evaluation, management, and
long-term clinical outcomes were documented. Data are summarized as count (n), geometric mean, median, or standard deviation as appropriate. Univariate differences
between treatment cohorts were analyzed using Chi-squared tests for categorical variables.
Nonparametric paired Wilcoxon signed-rank test and Mann–Whitney U-test were used for the analysis of paired ordinal or continuous data. A statistical
analysis was performed with SPSS software (SPSS Inc., Chicago, IL) with significance
defined at a P < 0.05 level.
Results
Imaging for suspected RAS was performed on 984 children. Of the 38 patients with positive
imaging for RAS, 60.5% were idiopathic, 31.5% (n = 12) had concomitant congenital/systemic comorbidity, and 21.0% (n = 8) had RAS and concomitant aortic pathology. Fibromuscular dysplasia only accounted
for 13.2% (n = 5) of patients. Regarding management, 34.2% (n = 13) underwent invasive intervention, 23.7% (n = 9) underwent endovascular intervention alone, and 10.5% (n = 4) underwent endovascular plus surgical intervention. Conservative management was
performed for 65.8% (n = 25) of patients at a long-term follow-up (33.8 months), 34.2% (n = 13) requiring only lifestyle changes, and 31.6% (n = 12) requiring only medical management.
Conclusions
Pediatric RAS is a low-frequency disease and long-term outcomes have been under-reported.
The incidence of associated aortic pathology in our intervention cohort appears higher
than that was previously reported. A long-term follow-up demonstrated that up to 65.8%
of patients could be managed successfully with conservative therapy.
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Article Info
Publication History
Published online: March 11, 2022
Accepted:
February 2,
2022
Received:
March 1,
2021
Footnotes
Meeting: 44th Vascular and Endovascular Surgery Society Annual Winter Meeting, January 30, 2020, Oral Presentation.
Table of Contents Summary: This retrospective review of pediatric renal artery stenosis at a single center demonstrated that 66% of patients with positive duplex ultrasound screening were able to be managed without surgical intervention.
Identification
Copyright
Published by Elsevier Inc.
