Abstract
Pediatric renovascular hypertension (RVH) is a significant cause of secondary hypertension
in children, often resulting from renal artery stenosis (RAS) due to nonatherosclerotic
etiologies such as fibromuscular dysplasia (FMD), mid aortic syndrome (MAS), and syndromic
conditions like neurofibromatosis type 1 (NF-1). Early diagnosis is critical to prevent
long-term complications, including renal dysfunction and cardiovascular disease. Diagnostic
evaluation begins with ultrasound, which, despite its limitations, remains the first-line
modality. Advanced imaging techniques such as CT angiography (CTA), MR angiography
(MRA), and digital subtraction angiography (DSA) provide detailed vascular assessment,
with DSA considered the gold standard. Adjunctive tools like intravascular pressure
measurements, intravascular imaging, and renal vein renin sampling supplement DSA.
Management should have multidisciplinary consensus and is tailored to the individual
patient. Pharmacological therapy is seldom sufficient and percutaneous transluminal
angioplasty is effective in many cases. Stent placement and surgical interventions
are reserved for refractory or complex cases. Chemical ablation in select cases and
emerging therapies such as renal denervation offer additional options. This review
outlines the current diagnostic and therapeutic approaches to pediatric RVH, emphasizing
the importance of personalized care and the role of specialist pediatric centers,
with experience in managing RVH, in optimizing outcomes.
Keywords
renal artery stenosis - fibro-muscular dysplasia - mid-aortic syndrome
