AN UNUSUAL CAUSE OF HYPERTENSION: BILATERAL ACCESSORY RENAL ARTERIES

Öz

Abstract Introduction: Hypertension in childhood is a significant risk factor for the subsequent development of vascular diseases in later life. It is recommended that all children with hypertension undergo investigation for potential secondary causes. The bilateral accessory renal artery represents a rare etiological factor in the development of renovascular hypertension. Case Report: We presented a hypertensive adolescent patient who was admitted to the pediatric emergency department with complaints of dizziness and dyspnea and was diagnosed with bilateral accessory renal arteries, which was a rare condition. In renal color Doppler ultrasonography, measurements of both renal arteries at the renal hilum and interlobar levels were identified as significant for diagnosing stenosis. CT angiography revealed right renal and additional accessory renal arteries. Conclusion: A multidisciplinary approach and individualized patient management are critical for the diagnosis and treatment of renal vascular diseases. In this case, a rare variation, bilateral accessory renal artery, was diagnosed during the investigation of hypertension etiology. It is recommended that renal CT imaging is utilized for the precise diagnosis of renal artery abnormalities in hypertensive children. References: 1- MJ Dillon. Renin and hypertension in childhood. Arch Dis Child. 1974; 49: 831–834. 2- Karadeniz AG, Ata Korkmaz HA, Çavuşoğlu İG. Turk Gogus Kalp Damar Cerrahisi Derg. 2019; 27: 241–244. 3- National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114 (2 Suppl 4th Report):555-576. 4- Lauder L, Ewen S, Tzafriri AR,et al. Renal artery anatomy in hypertensive patients study collaborators. Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1,000 patients with hypertension. Euro Intervention. 2018;14:121-128. 5- Ozkan U, Oguzkurt L, Tercan F, Kızılkılıç O, Koç Z, Koca N. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol 2006; 12:183-186. 6- Lobeck IN, Alhajjat AM, Dupree P, et al. The management of pediatric renovascular hypertension: a single center experience and review of the literature. J Pediatr Surg. 2018;53:1825-1831.

Anahtar Kelimeler

• accessory renal artery
• childhood
• secondary hypertension

ALIŞILMADIK BİR HİPERTANSIYON NEDENİ: BİLATERAL AKSESUAR RENAL ARTERLER

Öz

Giriş: Çocukluk çağındaki hipertansiyon, yaşamın ilerleyen dönemlerinde vasküler hastalıkların gelişimi için önemli bir risk faktörüdür. Hipertansiyonu olan tüm çocukların potansiyel ikincil nedenler açısından araştırılması önerilmektedir. Bilateral aksesuar renal arter renovasküler hipertansiyon gelişiminde nadir bir etiyolojik faktördür. Olgu Sunumu: Baş dönmesi ve nefes darlığı şikayetleri ile çocuk acil servisine başvuran ve nadir görülen bir durum olan bilateral aksesuar renal arter tanısı alan hipertansif bir ergen hasta sunulmuştur. Renal renkli Doppler ultrasonografide her iki renal arterin renal hilum ve interlobar seviyelerindeki ölçümleri stenoz tanısı için anlamlı olarak bulundu. BT anjiyografide sağ renal ve ek aksesuar renal arterler saptandı. Sonuç: Multidisipliner yaklaşım ve bireyselleştirilmiş hasta yönetimi renal vasküler hastalıkların tanı ve tedavisi için kritik öneme sahiptir. Bu olguda, hipertansiyon etiyolojisi araştırılırken nadir görülen bir varyasyon olan bilateral aksesuar renal arter tanısı konuldu. Hipertansif çocuklarda renal arter anormalliklerinin kesin tanısı için renal BT görüntülemenin kullanılması önerilmektedir. Kaynaklar: 1- MJ Dillon. Renin and hypertension in childhood. Arch Dis Child. 1974; 49: 831–834. 2- Karadeniz AG, Ata Korkmaz HA, Çavuşoğlu İG. Turk Gogus Kalp Damar Cerrahisi Derg. 2019; 27: 241–244. 3- National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114 (2 Suppl 4th Report):555-576. 4- Lauder L, Ewen S, Tzafriri AR,et al. Renal artery anatomy in hypertensive patients study collaborators. Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1,000 patients with hypertension. Euro Intervention. 2018;14:121-128. 5- Ozkan U, Oguzkurt L, Tercan F, Kızılkılıç O, Koç Z, Koca N. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol 2006; 12:183-186. 6- Lobeck IN, Alhajjat AM, Dupree P, et al. The management of pediatric renovascular hypertension: a single center experience and review of the literature. J Pediatr Surg. 2018;53:1825-1831.

Anahtar Kelimeler

• aksesuar renal arter
• çocukluk çağı
• sekonder hipertansiyon

Kaynakça

1. 1. MJ Dillon. Renin and hypertension in childhood. Arch Dis Child. 1974; 49: 831–834.
2. 2. Karadeniz AG, Ata Korkmaz HA, Çavuşoğlu İG. Turk Gogus Kalp Damar Cerrahisi Derg. 2019; 27: 241–244.
3. 3. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114 (2 Suppl 4th Report):555-576.
4. 4. Lauder L, Ewen S, Tzafriri AR, et al. Renal artery anatomy in hypertensive patients study collaborators. Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1,000 patients with hypertension. Euro Intervention. 2018;14:121-128.
5. 5. Lobeck IN, Alhajjat AM, Dupree P, et al. The management of pediatric renovascular hypertension: a single center experience and review of the literature. J Pediatr Surg. 2018;53:1825-1831.
6. 6. Ozkan U, Oguzkurt L, Tercan F, Kızılkılıç O, Koç Z, Koca N. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol 2006; 12:183-186.
7. 7. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140:e20171904.
8. 8. Litwin M, Kułaga Z. Obesity, metabolic syndrome, and primary hypertension. Pediatr Nephrol. 2021;36:825-837.