Objective: The objective of this multicenter study was to evaluate the clinical presentation and outcomes of children with renovascular hypertension (RVH) treated in the Czech Republic over 32 years. Design and method: A retrospective study of all children with RVH in three largest tertiary pediatric nephrology centres in the CZE between 1993 and 2024 was conducted. The clinical data collected were mode of manifestation, blood pressure (BP), kidney function, proteinuria, echocardiography, treatment procedure and outcome. Results: Altogether 70 children with median (range) age at angiography of 10.2 (0.1 – 18.4) years were included. The most common cause of RAS was fibromuscular dysplasia (44%, angiographic diagnosis). Sixteen children (23%) had an underlying syndrome/disease. 56 (80%) children had unilateral renal artery stenosis and (14) 20% bilateral. Symptoms at manifestation included mainly headache and nausea (n=30). In 40 asymptomatic children hypertension was revealed during regular follow-up or incidentally. The absolute BP values at manifestation were 167/106 mmHg and systolic and diastolic BP was 47/30 mmHg above the 95th pc. At manifestation, eGFR was normal in 76% of patients, echocardiography showed left ventricular hypertrophy (LVH) in 25/47 children (53%). Renal Doppler ultrasound was pathological in only 22 children (31%). Most children (n=63) underwent catheter-based digital subtraction angiography (DSA) for definitive diagnosis of RAS, in the remaining 7 children, RAS was verified by CTA. Altogether 52 percutaneous transluminal renal angioplasty (PTRA) procedures were carried out. Restenosis occurred in 8 children. Five children without PTRA underwent unilateral nephrectomy of afunctioning kidneys. The outcome was assessed using post-intervention BP categorization: BP was cured in 18 children (26%), improved in 38 (54%), failure of treatment occurred in 7 (10%) and technical failure of PTRA in 7 children (10%). Conclusions: This is one of the largest cohort studies of pediatric patients with renovascular hypertension, PTRA leads in the majority of children to cure or improvement.
Seeman et al. (Fri,) studied this question.