Reno-vascular hypertension in childhood: a nationwide survey |
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Authors: | Aysun K Bayazit Fatos Yalcinkaya Nilgun Cakar Ali Duzova Zelal Bircan Aysin Bakkaloglu Nur Canpolat Nazl Kara Aydan Sirin Mesiha Ekim Ayse Oner Sema Akman Sevgi Mir Esra Baskin Hakan M Poyrazoglu Aytul Noyan Ipek Akil Sevcan Bakkaloglu Alper Soylu |
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Institution: | (1) Department of Paediatric Nephrology, School of Medicine, Cukurova University, 01330, Balcali, Adana, Turkey;(2) Paediatric Nephrology, School of Medicine, Ankara University, Ankara, Turkey;(3) Paediatric Nephrology, SSK Diskapi Hospital, Ankara, Turkey;(4) Paediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey;(5) Paediatric Nephrology, School of Medicine, Kocaeli University, Izmit, Turkey;(6) Paediatric Nephrology, School of Medicine, Cerrahpasa University, Istanbul, Turkey;(7) Paediatric Nephrology, School of Medicine, Istanbul University, Istanbul, Turkey;(8) Paediatric Nephrology, Dr. Sami Ulus Children’s Hospital, Ankara, Turkey;(9) Paediatric Nephrology, School of Medicine, Akdeniz University, Antalya, Turkey;(10) Paediatric Nephrology, School of Medicine, Ege University, Izmir, Turkey;(11) Paediatric Nephrology, School of Medicine, Baskent University, Ankara, Turkey;(12) Paediatric Nephrology, School of Medicine, Erciyes University, Kayseri, Turkey;(13) Paediatric Nephrology, School of Medicine, Celal Bayar University, Manisa, Turkey;(14) Paediatric Nephrology, School of Medicine, Gazi University, Ankara, Turkey;(15) Paediatric Nephrology, School of Medicine, Dokuz Eylul University, Izmir, Turkey |
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Abstract: | Renovascular disease accounts for 8–10% of all cases of paediatric hypertension, whereas, in adults, its incidence is approximately
1%. The Turkish Paediatric Hypertension Group aimed to create the first registry database for childhood renovascular hypertension
in Turkey. Twenty of the 28 paediatric nephrology centres in Turkey responded to the survey and reported 45 patients (27 girls,
18 boys) with renovascular hypertension between 1990 and 2005. The age at presentation ranged from 20 days to 17 years. The
mean blood pressure at the diagnosis was 169/110 mmHg. Chief complaints of symptomatic patients were headache (38%), seizure
(18%), epistaxis (4%), growth retardation (4%), cognitive dysfunction (4%), polyuria (2%), palpitation (2%), and hemiplegia
(2%). Renovascular hypertension was found incidentally in 11 children. The diagnosis of renovascular hypertension was established
with conventional angiography in 39 patients, MR angiography in three, CT angiography in two, and captopril diethylene triamine
penta-acetic acid (DTPA) scintigraphy in one patient. Twenty-one children had bilateral renal artery stenosis and 24 had unilateral
renal artery stenosis. Of these, 14 (31%) had fibromuscular dysplasia; 12 (27%) Takayasu’s arteritis; six (13%) neurofibromatosis;
two (5%) Williams syndrome; one (2%) Kawasaki disease; one (2%) mid-aortic syndrome; one (2%) extrinsic compression to the
renal artery, and eight (18%) unspecified bilateral renal artery stenosis. Hypertension was controlled with antihypertensive
drugs in 17 patients. Percutaneous transluminal angioplasty (PTRA) or surgery had to be performed in 28 patients: PTRA in
16 patients, PTRA + surgery in one patient and surgery in 11 patients (four nephrectomies). The importance of vasculitic disease,
especially Takayasu’s arteritis, should not be underestimated in children with renovascular hypertension. |
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Keywords: | Renovascular hypertension Children Survey Etiology Treatment |
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