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1057. Pediatric Renal Artery Stenosis: A 19-Year Experience in Management and Outcomes at a Tertiary Pediatric Hospital
Authors * Denotes Presenting Author
  1. Kaci Dudley; Loma Linda University Medical Center
  2. Sharon Kiang; Loma Linda University Medical Center; VA Loma Linda Healthcare
  3. Hans Boggs; Loma Linda University Medical Center
  4. Roger Tomihama *; Loma Linda University Medical Center
Objective:
Pediatric renal artery stenosis (RAS) is a low frequency disease. Optimal management of pediatric RAS has not been established. We reviewed the diagnosis and the clinical course of pediatric RAS at our institution to provide insight into the outcomes and potential areas of improvement in the management of pediatric RAS.

Materials and Methods:
Imaging reports from US, CT, MRI and angiographic studies from 2000-2019 at an academic children’s hospital were reviewed. Images from positive reports were reviewed by a vascular surgeon and interventional radiologist to confirm a diagnosis of RAS (>60%). Patient charts with positive radiologic diagnosis were then reviewed for indication for RAS evaluation, demographics, clinical presentation, intervention and outcomes.

Results:
984 studies were reviewed and 42 patients were confirmed to have native kidney RAS >60%. Twenty-five (60%) were female and 17 (40%) were male, with a mean age of 9.7 years (range 0.04-17). Indication for RAS imaging included: 60%-renovascular HTN, 12%-association with degenerative neurological disorders, 9.5%-renal failure of unknown etiology, 7.1%-secondary to aortic interruption, 4.8% - other. Of the 42 patients with positive imaging, 30% underwent invasive procedures: 7% underwent angiography only, 9.5% underwent angioplasty with resolution of hypertension (all with FMD or neurofibromatosis), 11.9% underwent initial endovascular intervention but required subsequent open reconstruction and 2.4% required aortic stenting. There were 29 patients who did not undergo invasive treatments: 26% had resolution of HTN with life-style optimization, 9.5% were negative for RAS on follow up imaging, 12% with RAS congenital anatomic deformities, 4.8% related to traumatic injuries, 7% died of unrelated illness and 9.5% were lost to follow up.

Conclusion:
Pediatric RAS is a low frequency disease process. The majority of pediatric patients with RAS found by imaging (70%) did not require intervention. While endovascular therapy works well in pediatric patients with isolated renal artery disease, open revascularization was often needed in the setting of associated aortic pathology.