Renovascular hypertension should be suspected in a pediatric patient if certain findings are present.


Conditions associated with a very high rate of renovascular disease:

(1) vasculitis (Takayasu's. etc)

(2) renal transplant

(3) Williams's syndrome

(4) tuberous sclerosis

(5) neurofibromatosis

(6) history of radiation therapy with fields overlying a renal artery

(7) history of abdominal trauma

(8) history of renal artery thrombosis

(9) history of umbilical artery catheterization


Clinical features of the hypertension:

(1) very high blood pressure

(2) associated with complications (stroke, facial palsy, cardiac failure)

(3) uncontrolled by 2 or more antihypertensive drugs


Findings on clinical examination:

(1) bruits over the renal artery


Laboratory findings:

(1) elevated plasma rennin

(2) moderate to severe hypokalemia


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