Pediatric Renovascular Hypertension

Pediatric renovascular hypertension is high blood pressure due to narrowing or blocking of the arteries that carry blood to the kidneys. Reduced blood flow to the kidneys can lead to high blood pressure. This can lead to kidney failure and damage to other organs including the heart and lungs.

There are many causes of pediatric renovascular hypertension in children. They include:

• Middle aortic syndrome/aortic coarctation – This is when the aorta, which is the largest artery of the body, narrows. This can reduce blood flow to parts of the body, including the kidneys.
• Fibromuscular dysplasia – This is a condition that causes narrowing of the arteries. This blocks blood flow to the organs (like the kidneys).

Middle aortic syndrome is a rare condition in which part of the aorta that runs through the chest and abdomen becomes narrow, which can lead to lower blood flow in the chest, abdomen, and lower limbs.

At Children’s Hospital of Philadelphia (CHOP), the first step to care is a thorough evaluation conducted by a multidisciplinary team of experts.

Our technologists are specially trained and use the most advanced imaging technology available to make sure your child receives an accurate, detailed diagnosis. This is an important first step in offering a personalized treatment plan for your child. We give you the information you need to help you make informed decisions about your child’s care.

Our team may suggest imaging tests after checking your child’s medical history and doing a physical exam. These tests may include:

• Ultrasound
• Computed tomographic angiography (CTA)
• Magnetic resonance angiography (MRA)
• Direct angiography
• Intravascular imaging
• Contrast-enhanced ultrasound
• Perfusion imaging

Renovascular hypertension is a condition that requires coordinated, personalized and expert care. Our multidisciplinary team provides the full range of medical, surgical and endovascular (also called minimally invasive) care for children with this condition.

First line management is prescribing your child medication to help lower their blood pressure. If medication doesn’t help, or if the narrowing of the blood vessels is damaging one or both kidneys, we may consider doing vascular surgery. This is a treatment option that may improve blood flow to the kidneys.

One type of vascular surgery that can help renovascular hypertension caused by middle aortic syndrome is an aortic correction. This procedure helps bypass the narrowed part of the aorta, allowing for improved blood flow and lowering dangerously high blood pressure.

Vascular surgery in children and teens poses many challenges. It requires expert care from an experienced team of pediatric specialists. At CHOP, your child receives world-class care from that type of team. Our team includes specialists in general surgery, nephrology, interventional radiology, cardiology, cardiac surgery, hematology and genetics, among others. Our team works together to provide the best care and long-term follow-up for each patient..

This illustration shows aortic correction, a vascular surgery procedure that helps bypass the narrowed part of the aorta.

Whether your child was just diagnosed with renovascular hypertension, or you’ve been on this journey for a while and are looking for a second opinion, we are here to help.