Abstract
Objective: Accessory renal arteries may be related to the risk of renovascular hypertension. This study aims to evaluate the clinical course of accessory renal arteries in children with hypertension. We also aimed to compare renal function tests, blood pressure loads, frequency of end-organ damage, and prognosis of hypertensive patients who had detected single and accessory renal artery with Magnetic Resonance Angiography.
Material and Methods: From 01 January 2015 to 31 December 2017 medical records of hypertensive patients were retrospectively reviewed and patients who had been evaluated with Magnetic Resonance Angiography for differential diagnosis of renovascular hypertension were selected. Hypertensive patients with single renal arteries and those who had accessory arteries were compared in the terms of findings Doppler Ultrasound, blood pressure load, and presence of end-organ damage, laboratory investigations, treatment modalities, and prognosis.
Results: Of 49 hypertensive patients who underwent Magnetic Resonance Angiography, 26 (51%) showed accessory renal arteries. Despite the normal Doppler Ultrasound, 13 patients were found to have accessory renal artery with Magnetic Resonance Angiography. There was no significant difference between blood pressure load, and laboratory investigations between the patients with single renal arteries and those who had accessory renal arteries. The frequency of end-organ damage was also similar between both groups at the end of follow-up period as well as the number of medications.
Conclusion: Magnetic Resonance Angiography is more successful than Doppler Ultrasound to detect accessory renal artery. It seems that the presence of accessory renal arteries does not affect the prognosis of the disease.
Keywords: children, hypertension, renal artery
References
- Tullus K, Brennan E, Hamilton G, Lord R, McLaren CA, Marks SD, et al. Renovascular hypertension in children. Lancet 2008;371:1453-63.
- Marks DS, Tullus K. Update on imaging for suspected renovascular hypertension in children and adolescents. Curr Hypertens Rep 2012;14:591-5.
- Standring S, ed. Gray’s Anatomy. The Anatomical Basis of Clinical Practice. 40th Ed., Edinburg, Churchill & Livingstone 2008;1231-3.
- de Jong MR, Hoogerwaard AF, Gal P, Adiyaman A, Jaap Jan J Smit, Peter Paul H M Delnoy, et al. Persistent increase in blood pressure after renal nerve stimulation in accessory renal arteries after sympathetic renal denervation. Hypertension 2016;67: 1211-7.
- Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Roobs JV, Kalideen JM. Additional renal arteries: incidence and morphometry. Surg Radiol Anat 2001;23:33-8.
- Sinaiko AR, Gomez-Marin O, Prineas RJ. Prevalence of “significant” hypertension in junior high school- aged children: the Children and Adolescent Blood Pressure Program. J Pediatr 1989;114:664–9.
- Verdecchia P. Prognostic value of ambulatory blood pressure. Current evidence and clinical implications. Hypertension 2000;35:844–51.
- Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carrol AE, Daniels SR, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017;140: e20171904.
- Glodny B, Cromme S, Wortler K, Winde G. A possible explanation for the frequent concomitance of arterial hypertension and multiple renal arteries. Med Hypotheses 2001;56:129–33.
- Glodny B, Cromme S, Reimer P, Lennarz M, Winde G, Vetter H. Hypertension associated with multiple renal arteries may be renin-dependent. J Hypertens 2000;18:1437–44.
- Kem DC, Lyons DF, Wenzi J, Halverstadt D, Yu X. Renin-dependent hypertension caused by non-focal stenotic aberrant renal arteries: proof of a new syndrome. Hypertension 2005;46:380-5.
