ESPN 53rd Annual Meeting

ESPN 2021


 
Secondary Hypertension with Unremarkable Radiological Examinations but High Grade Stenosis in Angiography
MARA EGERER 1 MOHAMMED NASHAWI 1 PETER M√úLLER-ABT 2 FRANK UHLEMANN 3 AXEL ENNINGER 1 MARTIN BALD 4

1- DEPARTMENT OF PAEDIATRICS; OLGAHOSPITAL, KLINIKUM STUTTGART
2- DEPARTMENT OF PAEDIATRIC RADIOLOGY; OLGAHOSPITAL, KLINIKUM STUTTGART
3- DEPARTMENT OF PAEDIATRIC CARDIOLOGY; OLGAHOSPITAL, KLINIKUM STUTTGART
4- DEPARTMENT OF PAEDIATRIC NEPHROLOGY; OLGAHOSPITAL, KLINIKUM STUTTGART
 
Abstract:

 Objectives:

About 5-25% of arterial hypertension in children is caused by renovascular hypertension. Children suffering from this condition often show now significant clinical symptoms. 

 

Methods:

We hereby introduce a 2 years old patient with sever hypertension due to renal artery stenosis showed only in catheter angiography. 

 

Results:

The patient showed no symptoms and no abnormalities in the clinical examination. The blood pressure measurements showed pressures over the 95th percentile. Blood work, urine screening, echocardiography and kidney ultrasound showed normal results. In the MRI-Angiography no vascular abnormality could be seen, however the left kidney was smaller than the right one. Moreover, because of persisting high blood pressure despite 3 anti-hypertensive medications, a digital subtraction angiography has been done and showed a high-grade stenosis of the left renal artery with a string-of-beads appearance. A renal scintigraphy was conducted and showed a leading right kidney and a left kidney with a slightly delayed renal perfusion.

 

Conclusion:

Secondary arterial hypertension should always be considered in children with elevated blood pressure levels. If renal and endocrinologic causes can be ruled out, stenosis of vessels close to the heart and renal vessels is the most common reason for a secondary arterial hypertension. Comprehensive diagnostic should be considered to rule out renal artery stenosis. As presented in our case, MR angiography cannot always detect arterial blood vessel abnormalities. Therefore, catheter angiography should be taken in consideration to confirm the diagnosis of renal arterial stenosis.