Key result
CTA achieves ~100% sensitivity and specificity for pediatric renovascular hypertension, outperforming ultrasound and renin.
Why the study?
Catheter angiography is the criterion standard for diagnosing renovascular hypertension, while the utility of various blood tests and non-invasive imaging modalities in children remains unclear due to a lack of evidence.
Do non-invasive blood tests (PRA, aldosterone) and imaging modalities (kidney ultrasound, CT angiography) accurately diagnose renovascular hypertension compared with catheter angiography in children?
Observational (n=10)
Yes
Do non-invasive blood tests (PRA, aldosterone) and imaging modalities (kidney ultrasound, CT angiography) accurately diagnose renovascular hypertension compared with catheter angiography in children?
Answers are grounded in this paper and cite their sources.
In pediatric patients with suspected renovascular hypertension, screening with kidney ultrasound and plasma renin activity followed by CT angiography can accurately establish the diagnosis without requiring invasive catheter angiography or renal vein renin sampling.
BACKGROUND: Despite advances in non-invasive vascular imaging, detection of renal artery stenosis via catheter angiography is the criterion standard for the diagnosis of renovascular hypertension (RVH). However, because of lack of evidence, the utility of various blood tests and imaging modalities remains unclear. METHODS: We retrospectively analyzed the utility of blood tests (plasma renin activity [PRA], aldosterone, and renal vein renin [RVR] values) and imaging studies (computed tomography angiography [CTA], kidney ultrasonography [US]) by comparing them with catheter angiography. Ten pediatric patients with RVH at two institutions from January 2008 to December 2017 were recruited. The sensitivities for diagnosing RVH via imaging and blood tests (kidney [US], PRA, and aldosterone) were derived by examining patient records. Furthermore, the sensitivity and specificity of CT angiography were calculated by considering both the affected and non-affected renal arteries of the patients. RESULTS: A high sensitivity for diagnosing RVH via kidney US (89%) and PRA (80%) was observed. The sensitivity and specificity of CTA were 100%, each. RVR sampling did not aid in the diagnosis of RVH; only two of six patients with unilateral RVH showed significant laterality of RVR boundary ratios. Renal scintigraphy facilitated detection of a non-functional kidney (split renal function <5%). CONCLUSIONS: RVH in children could be diagnosed utilizing non-invasive blood and imaging tests, without catheter angiography. We recommend kidney length measurement along with measurement of PRA level, as a simple and highly useful screening test, followed by CTA as a diagnostic test.
No takes yet. Share an insight, caveat, or question.
Saida et al. (2020) conducted an observational in Renovascular hypertension (RVH) (n=10). Non-invasive blood tests (plasma renin activity, aldosterone, renal vein renin) and imaging modalities (CT angiography, kidney ultrasonography) vs. Catheter angiography (criterion standard) was evaluated on Diagnostic sensitivity and specificity for renovascular hypertension. CT angiography achieved 100% sensitivity and 100% specificity for diagnosing pediatric renovascular hypertension, while kidney ultrasound (89%) and plasma renin activity (80%) showed high sensitivity.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: