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Semin intervent Radiol
DOI: 10.1055/s-0045-1811577
Review Article

Pediatric Renovascular Hypertension: Diagnosis and Management

Kishore Minhas
1   Interventional Radiology, Radiology Department, Great Ormond Street Hospital for Children, Great Ormond Street, London, United Kingdom
,
Anne Marie Cahill
2   Interventional Radiology, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
,
Premal A. Patel 
1   Interventional Radiology, Radiology Department, Great Ormond Street Hospital for Children, Great Ormond Street, London, United Kingdom
3   Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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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


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Artikel online veröffentlicht:
16. September 2025

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