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Suba Rajinikanth

Dr M.G R Educational and Research Institute University, India

Presentation Title:

Rare case of renal artery stenosis with middle aortic syndrome presenting as hypertensive crisis

Abstract

Background:             
Pediatric hypertension is defined as systolic blood pressure > 95th percentile for age, sex, and height. In renal artery stenosis, the chronic ischemia leads to alteration of Renin-angiotensin-aldosterone axis resulting in secondary renovascular hypertension (RVH). Middle aortic syndrome is a rare genetic disease characterized by segmental or diffuse narrowing of the abdominal and or distal descending aorta with involvement of the renal and visceral branches. 

Case description:
Child was admitted with complaints of vomiting on and off for 6 months duration. On examination GCS 15/15, BP was 170/120 mm/Hg(>99%le). The Investigations revealed mild electrolyte abnormalities and Echo was normal. Renal artery Doppler was done which showed Left renal artery low velocity and low RI. CT renal Angio was done which showed Left main and left accessory renal artery stenosis (RAS) and diffusely enhancing soft tissue thickening noted around the visualized thoracic and abdominal aorta. PET CT confirmed RAS with MAS with no evidence of active inflammation in the present scan. Serum Renin level >500 and aldosterone level>100.Hence diagnosed as RVH due to Left renal artery stenosis. The Balloon angioplasty was done and left renal blood flow improved. Post procedure the child became normotensive and is on follow up.

Learning points:
•RVH though rare can have deleterious effect on the health of the child, so any child with vague complaints of vomiting and/or headache should be screened for hypertension.
•Vomiting with or without headache, uncontrolled HT should be evaluated by USG-KUB and Renal Doppler to rule out renal artery stenosis.
•Renal artery angioplasty is the gold standard treatment, results in complete reversal of hypertension in children. Early diagnosis and Early referral reduce morbidity and mortality in children.

Biography

Dr Suba Rajinikanth has completed her MBBS and Postgraduation in the specialty of Paediatrics from Madras Medical College, Chennai, India affiliated to Tamil Nadu DR MGR Medical University, Chennai, India. She holds a Membership from Royal college of Pediatrics and Child health,London,UK. She is the head of Medical and allied Research department of Dr MGR Educational and Research Institute. She is a Professor in the Department of Paediatrics, at Sri Lalithambigai Medical College (SLMC), Chennai, India. She has over 30 publications that are indexed in PMC, WOS, and Scopus. She has been serving as an expert peer review member of several reputed journals.