Imaging Renovascular Hypertension in Children

Renovascular hypertension can be caused by renal parenchymal disease, aorto-renal vascular disease, obstructive uropathy, endocrine, cardiac, pulmonary, or iatrogenic causes. However, throughout this chapter we will refer to renovascular hypertension caused by renal artery stenosis or aortic stenosis as in mid aortic syndrome. Renovascular hypertension (RVH) is an important cause of secondary hypertension in children because it is potentially curable and can lead to serious complications if left untreated. When RAS is suspected, non-invasive imaging options include Doppler US, scintigraphy, CT angiography (CTA) and MR angiography (MRA). However, digital subtraction angiography (DSA) is the gold standard even if it is invasive, adds additional risks related to sedation/anesthesia, and delivers higher radiation doses than CTA. The most commonly agreed upon approach includes screening with ultrasound (including color and spectral Doppler), followed by CTA in selected cases and confirmatory DSA for all those with high clinical suspicion.