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Compensatory Renal Growth Following Kidney Revascularization In Children With Renovascular Hypertension And Renal Artery Stenoses
Luciano Delbono, MD1, Peter Sienko, MD
2, Jessie Dalman
1, Nathaniel Putman
1, Brennan Callow
1, Jonathan Eliason
1, Robert Beaulieu
1, Zubin Modi
1, Jim Stanley
1, Dawn Coleman
3.
1University of Michigan, Ann Arbor, MI, USA,
2Brigham and Women's Hospital, Boston, MA, USA,
3Duke University, Durham, NC, USA.
OBJECTIVES: Pediatric renovascular hypertension (RVH) due to renal artery stenosis (RAS) is a potentially lethal disease if unrecognized and untreated. Its surgical management is well recognized, yet the treatment effects on renal preservation and growth remain ill-defined. This study aims to define the impaired renal growth distal to RAS and subsequent compensatory growth following kidney revascularization.
METHODS: Pediatric patients ≤20 years old having RVH and RAS who underwent renal revascularizations from 2010-2020 were identified, and those having quality preoperative and postoperative renal imaging (CT and ultrasound) were studied. Clinical data abstracted from hospital records documented the degree and manifestations of hypertension and the presence of hypertension-related end organ damage.
RESULTS: Thirteen children, 6 girls and 7 boys, undergoing unilateral (7) or bilateral (6) renal revascularizations for refractory RVH were studied. Their mean age at the time of diagnosis was 5.5 ±8.3 years, and at the time of revascularization 9.3 ±10 years. Postoperatively, significant decreases in severe hypertension occurred (p=0.02), associated with reductions in antihypertensive drugs (p=0.003), as well as resolution of left ventricular hypertrophy in all cases and proteinuria in 5 of 6 affected children.Among children with unilateral RAS undergoing renal revascularizations, their affected kidneys were significantly shorter than the contralateral unaffected kidney, relative to their expected kidney size, (-9.97 mm vs -3.89 mm; p= 0.03). No significant difference in the growth of affected vs unaffected kidneys was observed postoperatively, over an average follow up of 6.3 years (Figure 1). Similarly, among children undergoing revascularization for bilateral RAS exhibited preoperative kidneys smaller than predicted (-10.7 mm), but there was no difference in the growth post revascularization (-15.6 mm), over an average follow up of 9.6 years.
CONCLUSIONS: Kidneys distal to a unilateral RAS in children are markedly smaller in length and volume compared to unaffected contralateral kidneys when normalizing for patient height. Compared to unaffected kidneys, the post-revascularization growth of affected kidneys appears normal, and was not influenced by age at operation or time from the diagnosis to procedure. These findings support the benefit of renal revascularization in cases of pediatric RVH beyond improvement in blood pressure.
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