title: Renal Doppler evaluation in the child with hypertension: a reasonable screening discriminator?
abstract: BACKGROUND
  Hypertension is diagnosed in 1-5% of children, and 5-10% of those hypertensive children have renovascular disease. The gold standard for a diagnosis of renal artery stenosis is arteriography, and Doppler ultrasound (Doppler US) continues to be advocated as a useful screening test.
  
  
  OBJECTIVE
  The purpose of this study was to determine the utility of Doppler US in children as a screening tool and to better define clinical features of children in whom arteriography should be performed.
  
  
  METHODS
  This retrospective study evaluated the imaging and clinical parameters for all children who had a renal US with Doppler followed by a diagnostic arteriogram for the evaluation of hypertension during a 12-year period at a tertiary children's hospital. Sixty-two children were included. We evaluated each child's clinical parameters and placed each child into one of three categories of hypertension: mild, moderate or severe.
  
  
  RESULTS
  Eleven of 17 kidneys with proven renal artery stenosis were detected with Doppler US (sensitivity 64%). Six children with renal artery stenosis were missed by Doppler US, four of whom had segmental artery lesions. Of the children with positive renal artery stenosis on arteriography, all but three (79%) were classified as having moderate to severe hypertension.
  
  
  CONCLUSIONS
  Doppler US is a useful screening examination when evaluating children with hypertension, detecting renal artery stenosis in most affected children. The clinical risk classifications are helpful in guiding which children should proceed with arteriography regardless of the Doppler US results.
authors.affiliation: Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA.
authors.forename: Sumit
authors.initials: S
authors.lastname: Chhadia
authors.forename: Richard A
authors.initials: RA
authors.lastname: Cohn
authors.forename: Gulsah
authors.initials: G
authors.lastname: Vural
authors.forename: James S
authors.initials: JS
authors.lastname: Donaldson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging* / Q000209:etiology*; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015588:Observer Variation; D012078:Renal Artery Obstruction / Q000150:complications* / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods*