Endovascular therapy of renovascular hypertension in children: single center analysis.

INTRODUCTION: We present our results after percutaneous transluminal renal angioplasty (PTRA) and stent implantation in the treatment of eight children with renal artery stenosis (RAS) with consequential development of malignant renovascular hypertension (RVH) despite the administration of antihypertensive drugs. PATIENTS AND METHODS: In the period between January 2000 and November 2007, endovascular interventional procedures in the renal arteries were performed in 8 children (six boys and two girls) to treat malignant RVH caused by RAS. The mean patient age+/-standard deviation was 10.8 years+/-3.7 years (median age 9 years; range 8-17 years). Interdisciplinary discussion and evaluation of the indications for endovascular treatment was carried out for all of the eight patients. Our indications for the PTRA procedure were severe RVH with arterial blood pressure (BP) values above the 99th percentile, which did not respond to the administration of antihypertensive drugs. Renal artery stenting was performed due to re-stenosis after PTRA. RESULTS: Diagnostic digital subtraction angiography demonstrated unilateral RAS of the main renal artery in seven children and bilateral stenosis of the renal arteries in one child. We performed 11 endovascular interventions on 9 main renal arteries in 8 children (10 PTRA and one stent placement). In 7 of 8 children, complete correction of RAS was achieved. Follow-up assessment over a mean period of 39 months (range 6-84 months) showed normotension with no antihypertensive treatment in 6 children. One child had a technically successful PTRA and improved BP with reduced requirement for antihypertensive treatment. Technical failure of the endovascular intervention occurred in a boy with severe FMD who underwent successful surgical autotransplantation of the kidney. CONCLUSIONS: Endovascular therapy of RAS in children with consequential development of malignant RVH despite antihypertensive drugs represents the treatment of choice. PTRA and/or stent implantation are technically and clinically feasible and safe in this group of children. Optimal treatment results in children can be expected in a clinical environment with successful interdisciplinary cooperation between the pediatrician, interventional radiologist and pediatric surgeon.

Extracorporeal shock wave lithotripsy of impacted radiolucent stone at the right pyeloureteric junction and oral dissolution therapy in a patient with transplanted liver: a case report.

Extracorporeal shock wave lithotripsy (ESWL) is a safe, effective method to treat urinary lithiasis. The success rate in ESWL depends on stone location, size, number, and fragility as well as calceal anatomy and patency of the urinary tract. An association of calcineurin inhibitors and uric acid urolithiasis has been reported in renal allograft recipients, but the mechanism remains unknown. Herein we have reported the case of 68-year-old male patient who developed cryptogenic cirrhosis and underwent liver transplantation. Seven years after transplantation, the patient was admitted to the hospital with right renal colic. An 8.9-mm radiolucent stone at the pyeloureteric junction was associated with moderate consecutive hydronephrosis. The second stone was located in a lower renal calyx. After a failed attempt at retrograde ureteral stenting, we performed a percutaneous nephrostomy. Antegrade pyelography with following ESWL treatment resulted in disintegration of the obstructive stone at the pyeloureteric junction. Afterward, we performed antegrade placement of a double-J stent. Residual stones in the lower renal calyx were successfully treated with a 3-month course of oral intake of a dissolution agent-potassium sodium hydrogen citrate. In this case, we have discussed ESWL and oral dissolution therapy of radiolucent stones in a hydronephrotic right kidney, which resulted in stone-free disease after 3 months of combined therapy. There was neither clinical nor biochemical damage to the transplanted liver.