Importance of Imaging in Renal Vascular Conditions

Pediatric hypertension is often difficult to diagnose. Renovascular hypertension (RVH) may be responsible for about 5–25% cases of hypertension in children. It is usually diagnosed after a long delay because blood pressure is infrequently measured in children and high values are generally dismissed as inaccurate. Many children with renovascular disease have abnormalities of other blood vessels (aorta, cerebral, intestinal, or iliac). Individuals suspected of having the disorder can be investigated further with CT, MRI, or renal scintigraphy performed before and/or after administration of an angiotensin-converting enzyme inhibitor, but angiography is still the gold standard. Most children with renovascular disease require interventional or surgical treatment. Endovascular treatment with or without stenting will cure or reduce high blood pressure in more than half of all affected children. Surgical intervention, if needed, should be delayed, preferably until an age when the child is fully grown. Improved cardiac outcomes have been reported following endovascular and surgical interventions in this cohort of children. Modern treatment provided by a multidisciplinary team of pediatric nephrologists, interventional radiologists, and vascular surgeons offers good long-term treatment results. In this chapter, we provide cases to illustrate the clinical presentation, clinical course, and outcomes of these complex children.