Anatomic distribution of renal artery stenosis in children: implications for imaging.
BACKGROUND
Renal artery stenosis (RAS) causes significant hypertension in children. Frequently, pediatric RAS occurs with systemic disorders. In these cases, stenoses are often complex and/or include long segments. We believed that hypertensive children without comorbid conditions had a different lesion distribution and that the difference might have implications for imaging and treatment.


OBJECTIVE
To identify locations of RAS lesions in these hypertensive children without comorbid conditions.


METHODS
Patients who had renal angiography for hypertension from 1993 to 2005 were identified. Patients with systemic disorders, renovascular surgery, or normal angiograms were excluded. The angiograms of the remaining patients were reviewed for number, type, and location of stenoses.


RESULTS
Eighty-seven patients underwent renal angiography for hypertension; 30 were excluded for comorbid conditions. Twenty-one of the remaining 57 patients had abnormal angiograms; 24 stenoses were identified in those patients. All were focal and distributed as follows: 6 (25%) main renal artery, 12 (50%) 2nd order branch, 3 (12.5%) 3rd order branch, and 3 (12.5%) accessory renal artery.


CONCLUSIONS
Hypertensive children without comorbid conditions who have RAS usually have single, focal branch artery stenoses. This distribution supports angiography in these patients because of its superior sensitivity in detecting branch vessel disease and its therapeutic role in percutaneous transluminal renal angioplasty.
Vo
Nghia J
NJ
Department of Radiology, Division of Pediatric Interventional Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Hammelman
Ben D
BD
Racadio
Judy M
JM
Strife
C Frederic
CF
Johnson
Neil D
ND
Racadio
John M
JM
D000293:Adolescent; D000792:Angiography / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging* / Q000209:etiology; D007223:Infant; D008297:Male; D012078:Renal Artery Obstruction / Q000150:complications / Q000000981:diagnostic imaging*