McTaggart S J, Gulati S, Walker R G, Powell H R, Jones C L
Victorian Paediatric Renal Services, Royal Children's Hospital, Parkville, Australia.
Pediatr Nephrol. 2000 Sep;14(10-11):1022-9. doi: 10.1007/s004670050066.
Seventeen children with renovascular hypertension were managed at the Royal Children's Hospital, Melbourne, over the 20-year period from 1975 to 1996. The age at presentation ranged from 10 days to 18 years. All children presented with severe hypertension with mean systolic blood pressure 7 standard deviations above age-matched averages and mean diastolic blood pressure 5.5 standard deviations above age-matched averages. Neurofibromatosis was the most common etiology (58% of patients) and there were no cases of Takayasu's arteritis. Patients underwent a variety of biochemical and imaging investigations but in all cases renal angiography was necessary for definitive diagnosis and for planning therapy. Ten of the 17 patients had surgical procedures performed. Percutaneous transluminal angioplasty was performed in four patients but led to cure in only one patient following thrombosis of the affected artery producing segmental renal infarction. Other vascular reconstructive procedures, including the use of autologous or synthetic bypass grafts and autotransplantation, produced cure of hypertension in 50% of children with improvement in a further 30%. The long-term outlook for children treated with surgical reconstructive procedures was excellent. One patient underwent surgery for avulsion of an arterial graft following a pubertal growth spurt. No other patient originally cured by surgery has required reoperation with no cases of restenosis at a mean follow-up of 11 years 3 months.
1975年至1996年的20年间，墨尔本皇家儿童医院对17例肾血管性高血压患儿进行了治疗。就诊时的年龄从10天至18岁不等。所有患儿均表现为重度高血压，平均收缩压比同年龄组平均值高出7个标准差，平均舒张压比同年龄组平均值高出5.5个标准差。神经纤维瘤病是最常见的病因（占患者的58%），没有高安动脉炎病例。患者接受了各种生化和影像学检查，但在所有病例中，肾血管造影对于明确诊断和制定治疗方案都是必要的。17例患者中有10例接受了手术治疗。4例患者接受了经皮腔内血管成形术，但仅1例患者在患侧动脉血栓形成导致节段性肾梗死之后获得治愈。其他血管重建手术，包括使用自体或人工血管搭桥以及自体肾移植，使50%的患儿高血压得到治愈，另有30%的患儿病情有所改善。接受手术重建治疗的患儿远期预后良好。1例患者在青春期生长突增后因动脉移植物撕脱接受了手术。在平均11年3个月的随访中，最初接受手术治愈的其他患者均无需再次手术，也没有再狭窄病例。
