Impact of revascularization on hypertension in children with Takayasu’s arteritis-induced renal artery stenosis: a 21-year review
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’
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