Digital subtraction angiography in the evaluation of renal vascular hypertension in children.

Twenty children were evaluated with digital subtraction angiography (DSA) for renal vascular hypertension. IV DSA from a basilic vein approach was performed in four patients and femoral vein approach in two patients. Intraarterial DSA was performed in 14 patients with suspected renal vascular hypertension. Renal vein renin samples were obtained from 17 patients. Two renal artery angioplasties were performed in association with intraarterial DSA. IV DSA was diagnostic in five of six patients with one false-negative result for fibromuscular dysplasia of the tertiary vessels. Intraarterial DSA images were diagnostic in 14 of 14 patients, and renal vein renin results correlated well with DSA results. In 11 patients, DSA was performed as an outpatient (hospital day-care unit) procedure. Of the 20 patients evaluated, 13 patients had abnormal DSA findings which included a hypoplastic but functioning kidney in three patients, distal small vessel abnormalities in five patients, unilateral or peripheral renal artery stenosis in four patients, and middle aortic syndrome in one patient. DSA with renal vein renin samples can be used as a diagnostic procedure for the evaluation of renal vascular hypertension in children as well as adult patients. In addition, it is a useful tool for therapeutic vascular procedures in children.