ESPN 53rd Annual Meeting

ESPN 2021


 
Cerebrovascular Complications of Renovascular Disease in Children - Knowns and Unknowns
CHAVINI RANASINGHE 1 NADEESHA MUDALIGE 2 JELENA STOJANOVIC 3

1- DEPARTMENT OF UNDERGRADUATE MEDICINE, UNIVERSITY COLLEGE LONDON, 74 HUNTLEY ST, LONDON WC1E 6DE
2- UNIVERSITY COLLEGE LONDON GREAT ORMOND STREET INSTITUTE OF CHILD HEALTH, NIHR GREAT ORMOND STREET HOSPITAL BIOMEDICAL RESEARCH CENTRE, LONDON, UNITED KINGDOM
3- DEPARTMENT OF PEDIATRIC NEPHROLOGY, GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST, GREAT ORMOND STREET, LONDON, UNITED KINGDOM
 
Introduction:

Renovascular disease is an important cause of hypertension in childhood. Cerebrovascular complications are known to be associated with renovascular hypertension. However, the presenting features and phenotypic characteristics of this cohort with coexisting disease is undefined, therefore a literature review was conducted in order to further identify this group.

Material and methods:

A systematic review of cerebrovascular complications associated with renovascular hypertension in the global paediatric (<18 years) population. The MEDLINE, Embase and Google Scholar databases were searched, from database inception to 26th January 2021. Primary articles were not restricted by study design and geographical location but were limited to those published in English. 

Results:

303 individuals (median age: 7.6 years [range 10 days – 17.9 years], M:F – 174:129) from 37 studies were included, across 13 countries. Case reports published cases of 30 children with coexisting renovascular hypertension and cerebrovascular disease. Most children had bilateral renal artery stenosis (43%), stenosis secondary to fibromuscular dysplasia (53%) and coexisting occlusive cerebrovascular disease (50%). The majority (82%) presented with neurological symptoms and cerebral complications ranged from asymptomatic cerebrovascular stenosis in one child, to acute stroke in 51% and posterior reversible encephalopathy syndrome in 10%. The location or underlying etiology of the renovascular disease did not predict the location or extent of the cerebrovascular disease or the long-term prognosis of these children. The evidence from the 7 cohort studies included in the review were limited, estimating the prevalence of coexisting disease ranging from 16 - 79%, though none specifically established a cohort of children with coexisting disease. Furthermore, the conclusions drawn were subjected to considerable bias from the treating clinicians.

Conclusions:

A prospective cohort of children with renovascular hypertension and cerebrovascular complications should be established in order to better understand the long-term prognosis and impact of interventions.