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NDT Advance Access published online on October 21, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp537
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© The Author 2009. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Results of surgical treatment for renovascular hypertension in children: 30 year single centre experience

Marike B. Stadermann1, Giovanni Montini1, George Hamilton3, Derek J. Roebuck2, Clare A. McLaren2, Michael J. Dillon1, Stephen D. Marks1 and Kjell Tullus1

1 Department of Paediatric Nephrology and 2 Radiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, UK 3 Department of Vascular Surgery, Royal Free Hospital, London, UK

Correspondence and offprint requests to: Correspondence and offprint requests to: Kjell Tullus; E-mail: tulluk{at}gosh.nhs.uk



  Abstract

Background. We retrospectively reviewed the medical records of all patients who underwent surgery as part of the treatment of renovascular hypertension (RVH) at our centre between 1979 and 2008.

Patients. Thirty-seven children (65% male) with a median age of 7.6 (0.4–17.9) years were identified with a median systolic blood pressure (SBP) of 140 (105–300) mm Hg prior to surgery. Bilateral renal artery stenosis and intra-renal disease were present in 19 (51%) patients, mid-aortic syndrome in 15 (40%), involvement of visceral arteries in eight out of 35 (23%) and coexisting cerebral disease in eight out of 30 (26%) investigated patients.

Results. Surgical procedures (n = 53) included (i) nephrectomy (18, of which two unplanned and two secondary due to technical failure), (ii) renovascular surgery on the renal arteries (28, of which 18 had autologous surgery and 10 synthetic grafts inserted for revascularisation) and (iii) aortic reconstruction with (6) and without (1) a synthetic graft. Post-operative complications were haemorrhage (5), septicaemia (5) and chylous ascites (1). There were no perioperative deaths; two children died during follow-up. The SBP post-surgery improved to a median value of 116 (range 90–160) mm Hg. Twelve months after surgery, 16 (43%) children had normal blood pressure without treatment, 15 (41%) normal or improved on one to four antihypertensive drugs and four (11%) unchanged; no data were available for two (5%) children.

Conclusion. Surgery effectively treated the hypertension of 90% of our children, when performed in conjunction with medical therapy and interventional radiology. In spite of aggressive surgical treatment, RVH is sometimes a progressive disease.

Keywords: bypass; children; graft; nephrectomy; renovascular hypertension

Received for publication: 1. 6.09
Accepted in revised form: 18. 9.09


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