Renovascular Hypertension Differential Diagnoses
- Author: Rebecca J Schmidt, DO, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FACP, FASN more...
Clues to the presence of renovascular hypertension (RVHT) that might lead to serious complications (eg, stroke, renal failure, and cardiac decompensation) include the following:
- Recurrent and otherwise unexplained flash pulmonary edema or heart failure
- Recalcitrant hypertension that previously was controlled easily
- Hypertension that abruptly becomes more difficult to control and requires increased antihypertensive agents
- Slowly increasing serum creatinine levels, signifying the evolution of ischemic nephropathy
In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:
- Adrenal tumor
- Aortic insufficiency
- Arterial hypoplasia
- Cushing disease
- Cushing syndrome
- Essential hypertension
- Fibromuscular dysplasia
- Increased intracranial pressure
- Intracranial mass
- Moyamoya disease
- Other nonessential forms of hypertension
- Renal cyst
- Renal failure
- Renal hypoplasia
- Renal parenchymal disease
- Umbilical catheter embolism
Pediatric Congestive Heart Failure
[Guideline] Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the... Circulation. 2006 Mar 21. 113(11):e463-654. [Medline]. [Full Text].
Stanley JC, Zelenock GB, Messina LM, Wakefield TW. Pediatric renovascular hypertension: a thirty-year experience of operative treatment. J Vasc Surg. 1995 Feb. 21(2):212-26; discussion 226-7. [Medline].
Tyagi S, Kaul UA, Satsangi DK, Arora R. Percutaneous transluminal angioplasty for renovascular hypertension in children: initial and long-term results. Pediatrics. 1997 Jan. 99(1):44-9. [Medline].
Williams KM, Shah AN, Morrison D, Sinha MD. Hypertensive retinopathy in severely hypertensive children: demographic, clinical, and ophthalmoscopic findings from a 30-year British cohort. J Pediatr Ophthalmol Strabismus. 2013 Jul-Aug. 50(4):222-8. [Medline].
[Guideline] European Stroke Organisation, Tendera M, Aboyans V, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011 Nov. 32 (22):2851-906. [Medline]. [Full Text].
[Guideline] Parikh SA, Shishehbor MH, Gray BH, White CJ, Jaff MR. SCAI expert consensus statement for renal artery stenting appropriate use. Catheter Cardiovasc Interv. 2014 Dec 1. 84 (7):1163-71. [Medline]. [Full Text].
[Guideline] National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004 Aug. 114 (2 Suppl 4th Report):555-76. [Medline]. [Full Text].
Roditi G. MR in hypertension. J Magn Reson Imaging. 2011 Nov. 34(5):989-1006. [Medline].
Gloviczki ML, Lerman LO, Textor SC. Blood oxygen level-dependent (BOLD) MRI in renovascular hypertension. Curr Hypertens Rep. 2011 Oct. 13(5):370-7. [Medline].
Bakris GL, Townsend RR, Flack JM, Brar S, Cohen SA, D'Agostino R, et al. 12-month blood pressure results of catheter-based renal artery denervation for resistant hypertension: the SYMPLICITY HTN-3 trial. J Am Coll Cardiol. 2015 Apr 7. 65 (13):1314-21. [Medline].
Esler M. Illusions of truths in the Symplicity HTN-3 trial: generic design strengths but neuroscience failings. J Am Soc Hypertens. 2014 Aug. 8 (8):593-8. [Medline].
Jensen G, Annerstedt M, Klingenstierna H, Herlitz H, Aurell M, Hellström M. Survival and quality of life after renal angioplasty: a five-year follow-up study. Scand J Urol Nephrol. 2009. 43(3):236-41. [Medline].
Guzzetta PC. Arterial disease. Surgery of Infants and Children: Scientific Principles and Practice. Philadelphia, PA: Lippincott Williams & Wilkins; 1997:1722-4.:
Casalini E, Sfondrini MS, Fossali E. Two-year clinical follow-up of children and adolescents after percutaneous transluminal angioplasty for renovascular hypertension. Invest Radiol. 1995 Jan. 30(1):40-3. [Medline].
Jokhi PP, Ramanathan K, Walsh S, Fung AY, Saw J, Fox RS, et al. Experience of stenting for atherosclerotic renal artery stenosis in a cardiac catheterization laboratory: technical considerations and complications. Can J Cardiol. 2009 Aug. 25(8):e273-8. [Medline]. [Full Text].
Leesar MA, Varma J, Shapira A, Fahsah I, Raza ST, Elghoul Z, et al. Prediction of hypertension improvement after stenting of renal artery stenosis: comparative accuracy of translesional pressure gradients, intravascular ultrasound, and angiography. J Am Coll Cardiol. 2009 Jun 23. 53(25):2363-71. [Medline].
Cooper CJ, Murphy TP, Cutlip DE, Jamerson K, Henrich W, Reid DM, et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med. 2014 Jan 2. 370 (1):13-22. [Medline]. [Full Text].
Saad A, Herrmann SM, Crane J, Glockner JF, McKusick MA, Misra S, et al. Stent revascularization restores cortical blood flow and reverses tissue hypoxia in atherosclerotic renal artery stenosis but fails to reverse inflammatory pathways or glomerular filtration rate. Circ Cardiovasc Interv. 2013 Aug. 6(4):428-35. [Medline]. [Full Text].
Noory E, Sritharan K, Zeller T. To Stent or Not to Stent? Update on Revascularization for Atherosclerotic Renovascular Disease. Curr Hypertens Rep. 2016 Jun. 18 (6):45. [Medline].
Guzzetta PC, Potter BM, Ruley EJ, Majd M, Bock GH. Renovascular hypertension in children: current concepts in evaluation and treatment. J Pediatr Surg. 1989 Dec. 24(12):1236-40. [Medline].
O'Neill JA Jr. Renovascular hypertension. Semin Pediatr Surg. 1994 May. 3(2):114-23. [Medline].
Berkowitz HD, O'Neill JA Jr. Renovascular hypertension in children. Surgical repair with special reference to the use of reinforced vein grafts. J Vasc Surg. 1989 Jan. 9(1):46-55. [Medline].
Wheatley K, Ives N, Gray R, Kalra PA, Moss JG, Baigent C, et al. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med. 2009 Nov 12. 361(20):1953-62. [Medline]. [Full Text].
Böhlke M, Barcellos FC. From the 1990s to CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) trial results and beyond: does stenting have a role in ischemic nephropathy?. Am J Kidney Dis. 2015 Apr. 65 (4):611-22. [Medline].