title: Renovascular hypertension due to bilateral renal artery stenosis treated with stent implantation in a 12-year old girl.
abstract: Renovascular hypertension (RVH) in children is a relatively rare disease, but it is important in that it is a treatable condition when properly diagnosed. Percutaneous transluminal renal angioplasty (PTRA) with or without stenting is widely applied to adult patients with RVH. However, limited information is available as to PTRA with stenting in pediatric patients. We experienced a case of RVH in a 12-year-old girl, who had severe hypertension (180/110 mmHg). Bilateral renal artery stenosis was demonstrated by 3D-CT, MR angiography and selective renal arteriography. Renal function and plasma renin activity were normal. Angiotensin blockade was refrained for fear of functional deterioration of the kidney. Medical treatment with amlodipine insufficiently lowered the pressure to 140-160/80-100 mmHg, so we performed PTRA. Stenotic lesion and pressure gradient was still present after balloon angioplasty on both sides, prompting us to place LUMINEXX® stents on both renal arteries. Blood pressure dropped dramatically after the intervention. Amlodipine was discontinued, and then, enalapril and warfarin were administered to prevent neointima and thrombus formation. Her blood pressure and renal function was stable 18 months after PTRA. Oversized self-expanding stent such as LUMINEXX® stent could be used for renal artery stenting even in pediatric patients with RVH.
authors.affiliation: Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan. fumio@is.icc.u-tokai.ac.jp
authors.forename: Fumio
authors.initials: F
authors.lastname: Niimura
authors.forename: Shinichi
authors.initials: S
authors.lastname: Matsuda
authors.forename: Shojiro
authors.initials: S
authors.lastname: Okamoto
authors.forename: Eisuke
authors.initials: E
authors.lastname: Suganuma
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Takakura
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Sugiyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimizu
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Oh
authors.forename: Jun
authors.initials: J
authors.lastname: Koizumi
mesh_terms: D017130:Angioplasty; D000800:Angioplasty, Balloon; D002648:Child; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D012078:Renal Artery Obstruction / Q000150:complications* / Q000601:surgery*; D015607:Stents