Ladapo T.A., Gajjar P., McCulloch M., Scott C., Numanoglu A., Nourse P.
Pediatric Nephrology, Department of Pediatrics, College of Medicine, University of Lagos and Lagos University Teaching Hospital, PMB 12003, Lagos, Idi-Araba, Nigeria; Pediatric Nephrology, Department of Pediatric Medicine, Red Cross War Memorial Children’
Ladapo, T.A., Pediatric Nephrology, Department of Pediatrics, College of Medicine, University of Lagos and Lagos University Teaching Hospital, PMB 12003, Lagos, Idi-Araba, Nigeria; Gajjar, P., Pediatric Nephrology, Department of Pediatric Medicine, Red Cross War Memorial Children’s Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; McCulloch, M., Pediatric Intensive Care Unit, Red Cross War Memorial Children’s Hospital, School of Child and Adolescent Health, University of Cape Town., Cape Town, South Africa; Scott, C., Pediatric Rheumatology, Department of Pediatric Medicine, Red Cross War Memorial Children’s Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Numanoglu, A., Pediatric Surgery, Red Cross War Memorial Children’s Hospital, School of Child and Adolescent Health, University of Cape Town., Cape Town, South Africa; Nourse, P., Pediatric Nephrology, Department of Pediatric Medicine, Red Cross War Memorial Children’s Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
Background: Surgery for reno-vascular hypertension (RVH) is complex, and the techniques utilized vary with anatomical presentations of the disease. The long-term outcome of revascularization on RVH in children with Takayasu’s arteritis (TA)-induced renal artery stenosis (RAS) at our centre was reviewed. Methods: This study was a 21-year retrospective review of pre- and post-intervention RVH in children with angiographically confirmed RAS. The outcome of hypertension was defined as follows: (1) cured (normotensive off anti-hypertensives), (2) improved (normotensive on same or reduced number of medications), or (3) failure (no cure or improvement in number of medications). Results: The medical histories of 59 children (median age 9.98 years) were reviewed, of whom 20 (44 %) had revascularization procedures. All were hypertensive, with a mean systolic and diastolic blood pressure of 161.5 ± 36 and 106.5 ± 31 mmHg, respectively. RAS was present in 45 (76.3 %) children. Twenty-four revascularization procedures were performed in 20 children (44 %), of whom five had contralateral nephrectomies. Outcome was available for 17 patients at the 3- and 6-months follow-up, with cure, improvement and failure rates at 3 months of 2/17 (11.8 %), 7/17 (41.2 %) and 8/19 (47 %), respectively, and similar rates at 6 months. Associations between outcome and age (p = 0.51), sex (p = 0.32), number of pre-surgery anti-hypertensives (p = 0.18) and stenosis sites (p = 0.22) were not statistically significant. Conclusions: Revascularization was beneficial to the management of blood pressure control in about half of our RVH patients. © 2015, IPNA.
antihypertensive agent; cyclophosphamide; methotrexate; methylprednisolone; prednisone; antihypertensive therapy; aorta arch syndrome; artery bypass; Article; autograft; blood pressure regulation; child; childhood disease; controlled study; diastolic blood pressure; female; follow up; human; immunosuppressive treatment; kidney artery stenosis; kidney surgery; major clinical study; male; medical history; medical record review; nephrectomy; outcome assessment; percutaneous transluminal angioplasty; priority journal; renovascular hypertension; retrospective study; revascularization; single drug dose; aorta arch syndrome; complication; Hypertension, Renovascular; kidney transplantation; procedures; Renal Artery Obstruction; treatment outcome; vascular surgery; Child; Female; Humans; Hypertension, Renovascular; Kidney Transplantation; Male; Renal Artery Obstruction; Retrospective Studies; Takayasu Arteritis; Treatment Outcome; Vascular Surgical Procedures