Humbert J, Roussey-Kesler G, Guerin P, LeFrançois T, Connault J, Chenouard A, Warin-Fresse K, Salomon R, Bruel A, Allain-Launay E
Pediatric Nephrology Department, University Hospital of Nantes, Nantes, France.
Eur J Pediatr. 2015 Jan;174(1):23-32. doi: 10.1007/s00431-014-2355-x. Epub 2014 Jun 24.
Renovascular hypertension accounts for 5-10 % of hypertension cases in children; there is currently no consensus on treatment. Here, we report on our clinical experience with this disease and outline the different pathways in which to investigate it. We report retrospectively on ten children diagnosed with renovascular hypertension at the University Hospital of Nantes from 2001 to 2012. The main findings were obtained by fortuitous screening of children aged 2 months to 14 years old with neurofibromatosis (n = 2) and fibromuscular dysplasia (n = 8). The hypertension was always severe yet asymptomatic. Lesions were complicated in nine out of ten cases and included bilateral, multiple, mid-aortic syndrome and aneurysm. Doppler ultrasound associated with computed tomography allowed for a precise diagnosis in seven out of ten cases. Where ambiguities persisted, they were highlighted by arteriography, the gold standard investigation. Medical treatment was insufficient, leading to invasive procedures in nine out of ten children: 2 nephrectomies, 2 autotransplantations, and 21 repetitive percutaneous transluminal angioplasties. After invasive procedures, blood pressure control improved in four cases and was resolved in three.
Arteriography remains to be the gold standard technique for renovascular hypertension in children and can be combined with angioplasty when medical treatment is rendered obsolete. The role of computed tomography is controversial. Despite the heterogeneity of the children studied, we present a general medical and therapeutic management pathway for the treatment of this disease.
肾血管性高血压占儿童高血压病例的5% - 10%；目前对于其治疗尚无共识。在此，我们报告我们对该疾病的临床经验，并概述对其进行研究的不同途径。我们回顾性报告了2001年至2012年在南特大学医院诊断为肾血管性高血压的10名儿童。主要发现是通过对2个月至14岁患有神经纤维瘤病（n = 2）和纤维肌发育异常（n = 8）的儿童进行偶然筛查获得的。高血压总是严重但无症状。10例中有9例病变复杂，包括双侧、多发、主动脉中段综合征和动脉瘤。多普勒超声联合计算机断层扫描在10例中有7例得以精确诊断。当仍存在疑问时，通过血管造影（金标准检查）得以明确。药物治疗效果不佳，导致10名儿童中有9名接受了侵入性手术：2例肾切除术、2例自体肾移植术以及21次重复经皮腔内血管成形术。侵入性手术后，4例血压控制得到改善，3例血压恢复正常。
血管造影仍是儿童肾血管性高血压的金标准技术，当药物治疗无效时可与血管成形术联合使用。计算机断层扫描的作用存在争议。尽管所研究儿童存在异质性，但我们提出了针对该疾病治疗的一般医疗和治疗管理途径。
