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Logo of archdischfnArchives of Disease in Childhood - Fetal & NeonatalVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
Arch Dis Child Fetal Neonatal Ed. 2007 July; 92(4): F264.
PMCID: PMC2675423

Renal artery thrombosis and ischaemia presenting as severe neonatal hypertension

A baby boy (1460 g) was delivered at 30 weeks' gestation by caesarean section for preterm labour and fetal distress. Umbilical arterial and venous catheters were inserted between T8 and T9 briefly during the immediate postnatal period. On day 23, the baby was hypertensive (highest blood pressure 113/77 mm Hg; mean 88 mm Hg), but echocardiography revealed a structurally normal heart. Power Doppler ultrasound of the renal tract and vessels was normal. Multidetector computed tomographic (MDCT) angiography of the abdomen showed multiple narrowing defects within the main and posterior division of the left renal artery (fig 11)) and in the aorta at the origin of inferior mesenteric artery. Reduced perfusion in the upper pole of the left kidney was indicative of lobar ischaemia (fig 22).). Possible causes of the defects included thrombosis, arterial spasm and dysplastic vessels. Blood pressure normalised after labetalol infusion and the baby was weaned off antihypertensive treatment after seven days. MDCT angiography showed resolution of left kidney hypoperfusion and partial resolution of the narrowing defects. Clinical progress was compatible with multiple intra‐arterial thrombi, with subsequent resolution.

figure fn106666.f1
Figure 1 Enhanced axial CT image shows multiple foci of filling defects compatible with thrombi within the main and posterior division of the left renal artery (small arrows). Note the lack of cortical enhancement at the posterior lobe of the ...
figure fn106666.f2
Figure 2 Enhanced thick slab (6.5 mm) coronal image showing patchy enhancement of the left renal artery and its posterior division. Multiple segments of narrowing suggestive of intraluminal thrombi are indicated by the small arrows. There ...

Renal artery thrombosis as a complication of umbilical arterial catheterisation is a common cause of neonatal hypertension.1 MDCT angiography is highly useful in the investigation of neonatal hypertension when power Doppler ultrasound is inconclusive. With MDCT, we made the diagnosis within hours of presentation even though ultrasound findings were normal. Magnetic resonance angiography would have been impractical because of the long scanning time and the need for heavy sedation. Symptomatic management of blood pressure while awaiting resolution of the renal condition is usually successful,2 and may circumvent the technical difficulties of invasive interventions and avoid serious complications of treatment.3

Footnotes

Competing interests: None declared.

References

1. Merten D F, Vogel J M, Adelman R D. et al Renovascular hypertension as a complication of umbilical arterial catheterization. Radiology 1978. 126751–757.757 [PubMed]
2. Adelman R D, Merten D, Vogel J. et al Nonsurgical management of renovascular hypertension in the neonate. Pediatrics 1978. 6271–76.76 [PubMed]
3. Greenberg R, Waldman D, Brooks C. et al Endovascular treatment of renal artery thrombosis caused by umbilical artery catheterization. J Vasc Surg 1998. 28949–953.953 [PubMed]

Articles from Archives of Disease in Childhood. Fetal and Neonatal Edition are provided here courtesy of BMJ Publishing Group