title: Non-invasive imaging cannot replace formal angiography in the diagnosis of renovascular hypertension.
abstract: Renovascular disease (RVD) is found in about 10 % of secondary childhood hypertension. Digital subtraction angiography (DSA) is the gold standard to diagnose RVD. Non-invasive imaging methods like Doppler ultrasound (US), magnetic resonance angiography (MRA), and computed tomography angiography (CTA) are increasingly used. Our aim was to evaluate the role and accuracy of US, MRA, and CTA compared to DSA in diagnosing RVD in children.
  
  
  
  A retrospective review of 127 children with suspected renovascular hypertension was performed in children referred to Great Ormond Street Hospital between 2006 and 2014 due to clinical suspicion of renovascular hypertension and/or findings on US and/or MRA or CTA.
  
  
  
  Ninety-nine of 127 children (78 %) were diagnosed with renovascular disease and 80 were treated with percutaneous transluminal angioplasty during the same procedure. The median age at presentation was 5.6 (range, 2.5-10.6) years. Thirty-six children had unilateral renal artery stenosis in major extraparenchymal vessels, 47 bilateral stenosis and 16 intrarenal small vessel disease. US had a sensitivity of 63 % and specificity of 95 %. MRA and CTA were performed in 39 and 34 children, respectively. CTA sensitivity was slightly higher than that of MRA, 88 vs. 80 %, and specificity 81 vs. 63 %.
  
  
  
  The sensitivity of MRA and CTA is still too low to reliably rule out renovascular disease in children with a strong suspicion of this diagnosis. DSA remains the gold standard to diagnose renovascular hypertension and is recommended when clinical and laboratory criteria are highly suggestive of renovascular disease even with normal radiological investigations from non-invasive methods.
authors.affiliation: Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK.|Department of Pediatric Nephrology, University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.
authors.forename: Agnes
authors.initials: A
authors.lastname: Trautmann
authors.affiliation: Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roebuck
authors.affiliation: Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: Clare A
authors.initials: CA
authors.lastname: McLaren
authors.affiliation: Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: Eileen
authors.initials: E
authors.lastname: Brennan
authors.affiliation: Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Marks
authors.affiliation: Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK. kjell.tullus@gosh.nhs.uk.
authors.forename: Kjell
authors.initials: K
authors.lastname: Tullus
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000792:Angiography / Q000379:methods*; D015901:Angiography, Digital Subtraction; D017130:Angioplasty; D002648:Child; D002675:Child, Preschool; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging* / Q000628:therapy; D007223:Infant; D018810:Magnetic Resonance Angiography; D008297:Male; D012078:Renal Artery Obstruction / Q000150:complications / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color
keywords: Computed tomography angiography; Digital subtraction angiography; Doppler ultrasound; Magnetic resonance angiography; Renal artery stenosis; Renovascular hypertension