Pediatric Renovascular Hypertension: Manifestations and Management.

Renovascular hypertension (RVHTN) is an important contributor to secondary etiologies of hypertension in the pediatric population. A delay in diagnosis can be associated with adverse outcomes. The etiologies of renal artery stenosis (RAS) vary from anatomical, inflammatory, genetic syndromes, intra-luminal, external compression and idiopathic. It is a silent disease with isolated hypertension as its primary clinical manifestation. Laboratory values can be notable for electrolyte derangements and renal dysfunction, but are not universally present. The diagnosis requires a high index of clinical suspicion and entails ruling out other secondary causes of hypertension while monitoring for target organ damage. Imaging of individuals with suspected RAS includes: renal ultrasound, computed tomography angiography, magnetic resonance angiography and renal scintigraphy, but angiography continues to be the gold standard. Various factors are used to determine the most appropriate method for ongoing care: anti-hypertensive therapy, with or without radiological or surgical intervention. In all instances, a multi-disciplinary team approach should be used to provide optimal care to these children and adolescents.