Stenosing renal artery disease in children: clinicopathologic correlation and results of surgical treatment.

From 1955 to 1977, 27 pediatric patients underwent surgical treatment for renovascular hypertension. Renal artery disease was most commonly caused by intimal or perimedial fibroplasia and occurred bilaterally in 7 patients. Overall results were 16 patients cured (59%), 5 patients improved (19%) and 6 failures (22%). The best results were obtained in children with unilateral renal artery stenosis. In recent years, ablative surgery has been largely supplanted by reconstructive vascular procedures in the treatment of this disease in children. Autogenous vascular bypass grafts have been most successful and aortorenal reimplantation may occasionally be employed. Renal autotransplantation should be reserved for children with the middle aortic syndrome or multiple lesions involving the branches of the renal artery. Splenorenal bypass and segmental resection with renastomosis have yielded poor results and are best avoided in this age group. Primary nephrectomy should only be performed in patients with renal atrophy or uncorrectable branch vessel disease. Renovascular hypertension in children is a potentially curable disease and revascularization with preservation of renal function should be the combined objectives of surgical therapy in the most cases.