Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
Pediatric Nephrology Unit, Department of Pediatrics, Faculty of Medicine, UFMG, Avenida Alfredo Balena, 190, 2nd floor, room #281, Belo Horizonte, MG, 30130-100, Brazil.
Pediatr Nephrol. 2021 Dec;36(12):3853-3868. doi: 10.1007/s00467-021-05063-2. Epub 2021 Apr 13.
Renovascular hypertension (RVH) is defined as an elevated blood pressure caused by kidney hypoperfusion, generally as a result of anatomic stenosis of the renal artery with consequent activation of the Renin Angiotensin-Aldosterone System. The main causes include genetic and inflammatory disorders, extrinsic compression, and idiopathic alterations. RVH is often asymptomatic and should be suspected in any child with refractory hypertension, especially if other suggestive findings are present, including those with severe hypertension, abdominal bruit, and abrupt fall of glomerular filtration rate after administration of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. There is a consensus that digital subtraction angiography is the gold standard method for the diagnosis of RVH. Nevertheless, the role of non-invasive imaging studies such as Doppler ultrasound, magnetic resonance angiography, or computed tomographic angiography remains controversial, especially due to limited pediatric evidence. The therapeutic approach should be individualized, and management options include non-surgical pharmacological therapy and revascularization with percutaneous transluminal renal angioplasty (PTRA) or surgery. The prognosis is related to the procedure performed, and PTRA has a higher restenosis rate compared to surgery, although a decreased risk of complications. This review summarizes the causes, physiopathology, diagnosis, treatment, and prognosis of RVH in pediatric patients. Further studies are required to define the best approach for RVH in children.
肾血管性高血压(RVH)定义为肾脏灌注不足引起的血压升高,通常是由于肾动脉解剖学狭窄导致肾素血管紧张素醛固酮系统激活所致。主要病因包括遗传和炎症性疾病、外在压迫和特发性改变。RVH 通常无症状,在任何患有难治性高血压的儿童中均应怀疑该病,尤其是存在其他提示性发现时,包括严重高血压、腹部杂音和血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂给药后肾小球滤过率突然下降的儿童。数字减影血管造影术被认为是诊断 RVH 的金标准方法,但包括多普勒超声、磁共振血管造影或计算机断层血管造影在内的非侵入性影像学研究的作用仍存在争议,尤其是因为儿科证据有限。治疗方法应个体化,治疗选择包括非手术药物治疗和经皮腔内肾血管成形术(PTRA)或手术血运重建。预后与所进行的手术有关,与手术相比,PTRA 的再狭窄率较高,但并发症风险降低。本文总结了儿科患者 RVH 的病因、病理生理学、诊断、治疗和预后,需要进一步研究来确定儿童 RVH 的最佳治疗方法。