Abstract
Twelve neonates with hypertension have been followed for a mean of 5.75 years. At onset of hypertension, mean peak blood pressure was 159/99 mmHg. Ten infants had umbilical artery catheters, 9 placed above the origin of the renal arteries. Radionuclide renal scan, and/or angiography demonstrated renovascular disease, primarily renal artery thrombosis, in 11 infants. Onethird of infants were asymptomatic, one-third had normal urinalyses and two-thirds had elevated peripheral plasma renin activities. Blood pressure normalized with medical therapy in all infants and remained normal when therapy was discontinued. Ten infants have normal creatinine clearances on follow-up but 5/11 have unilateral renal atrophy. Radionuclide scans have remained abnormal, even in infants without renal atrophy. In summary, neonatal renovascular hypertension is frequently secondary to renal artery thrombosis, associated with umbilical artery catheterization. Blood pressure usually normalizes with conservative medical management and remains normal off medications. Persistent abnormalities in renal size and function are common.
Similar content being viewed by others
References
Ljungquist A, Wallgren G (1962) Unilateral renal artery stenosis and fatal arterial hypertension in a newborn infant. Acta Paediatr 51: 575–584
Cook GT, Marshall VF, Todd JE (1966) Malignant renovascular hypertension in a newborn. J Urol 96: 863–866
Woodard JR, Patterson JH, Brinsfield D (1967) Renal artery thrombosis in newborn infants. Am J Dis Child 114: 191–194
Angella JJ, Sommer LS, Poole C, Fogel B (1968) Neonatal hypertension associated with renal artery hypoplasia. Pediatrics 41: 524–526
Rahill WJ, Molteni A, Hawking KM, Koo J, Menon VA (1974) Hypertension and narrowing of the renal arteries in infancy. J Pediatr 84: 39–44
Juncos LI, DeTure FA, Walker RD, Madorsky ML (1976) Renin-Dependent renovascular hypertension in infant with abdominal aortic atresia. Urology 7: 628–631
Munoz AI, Baralt JF, Melendez MT (1977) Arterial hypertension in infants with hydronephrosis. Am J Dis Child 131: 38–40
Evans DJ, Silverman M, Bowley NB (1981) Congenital hypertension due to unilateral renal vein thrombosis. Arch Dis Child 56: 306–308
Knowlson, GT, Marsden HB (1978) Aortic thrombosis in the newborn period. Arch. Dis Child 53: 164–166
Borromeo-McGrail V, Bordiuk JM, Keitel H (1973) Systemic hypertension following ocular administration of 10% phenylephrine in the neonate Pediatrics 51: 1032–1036
Monteleone, JA (1969) Hypertensive encephalopathy with overdosage of deoxycorticosterone. Pediatrics 43: 294–295
DeStefano P, Bongo IG, Borgna-Pignatti C, Severi F (1983) Factitious hypertension with mineralocorticoid excess in an infant. Helv Paediatr Acta 38: 185–189
Eason E, Costom B, Papageorgiou AN (1982) Hypertension in neonatal thyrotoxicosis. J Pediatr 100: 766–768
Sheftel DN, Hustead V, Friedman A (1983) Hypertension screening in the follow-up of premature infants. Pediatrics 71: 763–766
Field ML, Roy S, Stapleton FB (1985) Low-renin hypertension in young infants. Am J Dis Child 139: 823–825
Adelman RD, Sherman MP (1980) Hypertension in the neonate following closure of abdominal wall defects. J Pediatr 97: 642–644
Gilboa N, Urizar RE (1983) Severe hypertension in newborn after pyeloplasty of hydronephrotic, kidney. Urology 22: 179–182
Abman SH, Warady BA, Lum GM, Koops BL (1984) Systemic hypertension in infants with bronchopulmonary dysplasia. J Pediatr. 104: 928–931
Ford KT, Teplick SK, Clark RE (1974) Renal artery embolism causing neonatal hypertension. Radiology 113: 169–170
Bauer SB, Feldman SM, Gellis SS, Retik A (1975) Neonatal hypertension: A complication of umbilical artery catheterization. N Engl J Med 293: 1032–1033
Plummer LB, Kaplan GW, Mendoza SA (1976) Hypertension in infants-a complication of umbilical artery catheterization. J Pediatr 89: 802–805
Durante D, Jones D, Spitzer R (1976) Neonatal renal arterial embolism syndrome. J Pediatr 89: 978–981
Adelman RD (1978) Neonatal hypertension. Pediatr Clin North Am 25: 99–110
Adelman RD, Merten D, Vogel J, Goetzman BW, Wennberg RP (1978) Nonsurgical management of renovascular hypertension in the neonate. Pediatrics 62: 71–76
Merten DF, Vogel JM, Adelman RD, Goetzman BW, Bogren HG (1978) Renovascular hypertension as a complication of umbilical arterial catheterization. Radiology 126: 751–757
Gross RE (1945) Arterial embolism and thrombosis in infancy. Am J Dis Child 70: 61–73
Zuelzer WW, Kurnetz R, Newton WA (1951) Circulatory diseases of the kidneys in infancy and childhood. IV. Occlusions of the renal artery. Am J Dis Child 81: 21–46
Gupta JM, Robertson NRQ, Wigglesworth JS (1968) Umbilical artery catheterization in the newborn. Arch Dis Child 43: 382–387
Wigger HJ, Bransilver BR, Blanc WA (1970) Thromboses due to catheterization in infants and children. J Pediatr 76: 1–11
Neal WA, Reynolds JW, Jarvis CW, Williams HJ (1972) Umbilical artery catheterization: Demonstration of arterial thrombosis by aortography. Pediatrics 50: 6–13
Goetzman BW, Stadalnik RC, Bogren HG, Blankenship HJ, Ikeda RM, Thayer J (1975) Thrombotic complications of umbilical artery catheters: A clinical and radiographic study. Pediatrics 56: 374–379
Tyson JE, DeSa DJ, Moore S (1976) Thromboatheromatous complications of umbilical arterial catheterization in the newborn period. Arch Dis Child 51: 744–754
Dimmick JE, Patterson MW, Wu HW (1979) Systemic hypertension in a newborn infant. J Pediatr 95: 321–324
Arakawa K, Torri S, Naito S Minohara A, Yemura N, Nakamura M. (1970) Plasma renin activity as a more specific diagnostic aid for renal infarction. Arch Intern Med 125: 830–834
Wesstrom G, Finnstrom O, Stepport G (1979) Umbilical artery catheterization in newborns. 1. Thrombosis in relation to catheter type and position. Acta Paediatr Scand 68: 575–581
Hoxie HJ, Coggins CB (1940) Renal infarction. Statistical study of two hundred and five cases and detailed report of an unusual case. Arch Intern Med 65: 587–594
Peterson NE, McDonald DF (1968) Renal embolization. J Urol 100: 140–145
Lessman RK, Johnson SF, Soburn JW, Kaufman JJ (1978) Renal artery embolism. Clinical features and long-term follow-up of 17 caces. Ann Intern Med 89: 477–482
Bracken RB, Johnson DE, Goldstein HM, Walber S, Ayala A. (1975) Percutaneous transfemoral renal artery occlusion in patients with renal carcinoma. Urology 6: 6–10
Adelman RD (1981) The epidemiology of neonatal hypertension. In: Giovannelli G New MI, Gorini S (eds) Hypertension in children and adolescents. Raven Press, New York pp 21–30
O'Neil JA, Neblett WW, Born ML (1981) Management of major thromboembolic complications of umbilical artery catheters. J Pediatr. Surg. 16: 972–978
Burdick JF, Helikson MA, Hudak ML, Williams GM (1982) Revascularization for bilateral renal artery occlusion after umbilical artery catheterization. Surgery 91: 650–654
Krueger TC, Neblett WW, O'Niel JA, MacDonald RC, Dean RH, Thieme GA (1985) Management of aortic thrombosis secondary to umbilical artery catheters in neonates. J Pediatr Surg 20: 328–332
Siegler RL (1976) Conservative management of neonatal renal artery embolism. Urology 8: 484–487
Baldwin CE, Holder TM, Ashcraft KW, Amoury RA (1981) Neonatal renovascular hypertension — a complication of aortic monitoring catheters. J Pediatr Surg 16: 820–821
Moyer JD, Rao CN, Widrich WC, Olsson CA (1973) Conservative management of renal artery embolus. J Urol 109: 138–143
Malin SW, Baumgart S, Rosenberg HK, Foreman J (1985) Nonsurgical management of obstructive aortic thrombosis complicated by renovascular hypertension in the neonate. J Pediatr 106: 630–634
Bifano E, Post EM, Springer J Williams ML, Streeton DH (1982) Treatment of neonatal hypertension with captopril. J Pediatr 100: 143–146
Abrams HL, Cornell SH (1965) Patterns of collateral flow in renal ischemia. Radiology 84: 1001–1012
Schambelan M, Glickman M, Stockigt JR, Biglieri E. (1974) Selective renal vein renin sampling in hypertensive patients with segmental renal lesions. N Engl J Med 290: 1153–1158
Dillon MJ (1974) Renin and hypertension in childhood. Arch Dis Child 49: 831–834
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Adelman, R.D. Long-term follow-up of neonatal renovascular hypertension. Pediatr Nephrol 1, 35–41 (1987). https://doi.org/10.1007/BF00866882
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00866882