Severe renovascular hypertension in an asymptomatic child-11 years of follow up

Introduction Renovascular hypertension is a rare cause of arterial hypertension in the pediatric population. The aim of this report was to present the treatment outcome in a girl with severe stenosis of the renal artery on a solitary kidney. Case outline A 6.5-year-old girl, otherwise healthy, was found to be highly hypertensive (up to 200/140 mmHg) during a systematic examination for school enrollment. The imaging evaluation revealed that she had a single kidney with critical renal artery stenosis. Medication with three antihypertensive drugs was unsuccessful. The angioplasty attempt was complicated by artery wall dissection and the pseudoaneurysm development. This complication was treated surgically with an autologous saphenous vein graft by-pass. Postoperatively, acute kidney injury developed, which required continuous renal replacement therapy for two days, followed by hemorrhagic shock and the need for reintervention with retroperitoneal hematoma evacuation. After three years, aneurismal dilated vein graft was replaced by a synthetic one (PTFE) in London. Angioplasty of the synthetic graft was performed twice due to the development of proximal stenosis and restenosis. After 11 years of follow-up, the girl has well controlled blood pressure under two antihypertensives, with normal renal function without proteinuria. Conclusion This case illustrates that angioplasty for single artery stenosis in children is a high-risk procedure, which may result in an aneurism formation or bleeding and a need for several kidney revascularization procedures. In order to preserve kidney function, it requires a serious multidisciplinary approach by nephrologists, interventional radiologists/cardiologists, and vascular surgeons.