Renovascular Hypertension, Surgical Treatment Differential Diagnoses

  • Author: Andre Hebra, MD; Chief Editor: Mary C Mancini, MD, PhD   more...
 
Updated: Aug 8, 2008
 
 

Differential Diagnoses

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Contributor Information and Disclosures
Author

Andre Hebra, MD  Chief, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, Medical University of South Carolina College of Medicine

Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Patrick B Thomas, MD  Fellow, Department of Pediatric Surgery, Texas Children's Hospital

Patrick B Thomas, MD is a member of the following medical societies: American Medical Association and South Carolina Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jonah Odim, MD, PhD, MBA  Senior Medical Officer, Transplantation Immunology Branch, Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health

Jonah Odim, MD, PhD, MBA is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physician Executives, American College of Surgeons, American Heart Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, Association for Academic Surgery, Association for Surgical Education, Canadian Cardiovascular Society, International Society for Heart and Lung Transplantation, National Medical Association, New York Academy of Sciences, Royal College of Physicians and Surgeons of Canada, Society of Critical Care Medicine, and Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

John Myers, MD  Director, Pediatric and Congenital Cardiovascular Surgery, Departments of Surgery and Pediatrics, Professor, Penn State Children's Hospital, Milton S Hershey Medical Center

John Myers, MD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Cardiology, American College of Surgeons, American Heart Association, American Medical Association, Congenital Heart Surgeons Society, Pennsylvania Medical Society, and Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Mary C Mancini, MD, PhD  Professor and Chief, Cardiothoracic Surgery, Department of Surgery, Louisiana State University Health Sciences Center-Shreveport

Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association

Disclosure: Nothing to disclose.

References

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  25. Simunic S, Winter-Fuduric I, Radanovic B, et al. Percutaneous transluminal renal angioplasty (PTRA) as a method of therapy for renovascular hypertension in children. Eur J Radiol. Mar-Apr 1990;10(2):143-6. [Medline].

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Aortogram of a 4-year-old child with renovascular hypertension caused by stenosis of the left renal artery. Note that the left kidney has 2 renal arteries, and the artery to the superior pole has stenosis.
Close-up view of the same arteriogram described above. The stenotic lesion begins at the ostium of the left superior renal artery. This lesion was caused by fibromuscular dysplasia and did not respond well to balloon angioplasty.
Operative photograph of the patient described above. The patient underwent aortorenal bypass using a reinforced saphenous vein graft. The inferior pole renal artery was preserved.
Aortogram of an 8-year-old child with neurofibromatosis and renovascular hypertension caused by right renal artery stenosis.
Operative photograph of the patient shown above. An aortorenal bypass was performed using saphenous vein graft reinforced with Dacron. The aorta is completely exposed as observed in this picture, and the graft is visible inferior to the native renal artery.
Although nephrectomy is rarely indicated in the treatment of renovascular hypertension in children, it can be safely performed using modern pediatric surgical laparoscopy technique. This 3-month-old child with renal dysplasia and refractory hypertension underwent laparoscopic nephrectomy. The photograph illustrates the patient positioning and the placement of small trocars at the time of the nephrectomy. The dysplastic kidney was easily removed through a slightly enlarged umbilical incision.
Same patient shown above. The photograph was taken immediately after laparoscopic nephrectomy. This patient was discharged from the hospital 2 days after surgery. This approach eliminates the need for large incisions and facilitates recovery from surgery, minimizing pain and length of hospital stay.
 
 
 
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