Renal artery stenosis (RAS) is a relatively common cause of secondary hypertension, accounting for 1% of unselected hypertensive children, but rises to as high as 10 to 40% in patients with severe or refractory hypertension [1, 2]. Bilateral RAS or unilateral disease in a single kidney with acceptable GFR can be associated with persistent hypertension and progressive renal dysfunction [3]. Renovascular hypertension (RVH) can be asymptomatic or an incidental finding [3].
The blood pressure of the affected children can be controlled with combination of mild diuretic and angiotensin-converting enzyme (ACE) inhibitors or an angiotensin 2 receptor blocker (ARBs).
Captopril- or enalapril- enhanced renal scintigraphy with either 99mtechnetium-diethylene triamine penta-acetic acid (99mTc-DTPA), 99mtechnetium-ethylenedicysteine (99mTc-EC) or 99mtechnetium-mercapto acetyl triglycine (99mTc-MAG3) is a widely accepted tool for the diagnosis of hemodynamically significant renal artery stenosis (RAS) [4, 5]. Although not as popular as the above mentioned radiotracers, captopril- or enalapril-enhanced 99mTc-DMSA is also used for the diagnosis of RAS with good sensitivity and specificity [6].
We are reporting a child with severe hypertension that was suspected to have bilateral RAS based on 99mTc-DMSA findings. The diagnosis was confirmed by computed tomography (CT) angiography.