Stenosing renal artery disease in children

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Stenosing renal artery disease in hypertensive children encompasses a wide spectrum of clinical and pathologic parameters.1–9 Since 1955, 20 children, 12 girls and 8 boys aged 1 to 18 years, were treated surgically at the Cleveland Clinic Hospital for renovascular hypertension (Table). Thirteen of the children were asymptomatic, but were noted to be hypertensive during the course of routine physical examination. Preoperative diastolic blood pressures ranged between 95 and 140 mm Hg. Eight of the 20 children had bilateral stenosing renal artery disease and three had associated extrarenal artery disease. In addition, two other children had bruits over the femoral and carotid arteries, although confirmation of stenosing artery disease by arte-riography was not obtained. One girl (case 18) also had clinical von Recklinghausen’s neurofibromatosis. No cases of renal artery stenosis associated with congenital rubella were encountered. Renal artery stenosis due to atherosclerosis, posttraumatic thrombosis, embolus, or extrinsic compression of the renal artery was excluded from this study. Also excluded were children in whom nephrectomy was performed without removal of the stenotic arterial segment. Surgical therapy included either revascularization or nephrectomy.

The pathologic classification of fibrous and muscular renal artery disease is based upon the layer of the arterial wall involved.10 The stenosing lesions in this series included intimal fibroplasia, medial hyperplasia, perimedial fibroplasia, and medial dissection.

Primary intimal fibroplasia (cases 1 through 6) is an extremely rare cause of renovascular hypertension in adults,10 yet was a common variant in the pediatric group. The arterial segments with loss of internal elastica . . .



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