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An eight-year-old Caucasian girl is referred for further evaluation after a routine school health examination showed a blood pressure of 150/90 mmHg, even after adequate rest. She is completely asymptomatic.

She has no medical history of clinical significance. She is not on any medications, including over-the-counter drugs or herbal supplements. Her family history is unremarkable. Her growth and development are normal. All immunizations are up-to-date. Her nutritional status is good.

A complete blood count is within normal parameters.

Select Relevant Investigations
Renal functions + electrolytes

Performed

Serum creatinine: 0.58 mg/dL (0.44-0.72)
Blood urea nitrogen: 13 mg/dL (7-20)

Serum Na+: 132 mEq/L (132-140)
Serum K+: 3.8 mEq/L (3.5-4.8)
Serum Cl-: 101 mEq/L (95-102)
Plasma renin activity

Performed

Plasma renin activity: 10.5 ng/mL/hour (0.5-5.9)
Renal ultrasound + doppler studies

Performed

Both kidneys are of normal size. The left kidney shows a pulsus parvus et tardus Doppler waveform, with a renal arterial resistive index (RI) of 0.9 (normal: <0.5). The right kidney shows normal Doppler waveforms and a renal artery RI of 0.4.
Magnetic resonance angiography

Performed

There is focal stenosis (~60%) of the middle and distal portions of the left renal artery. Multiple collaterals are present. The right renal artery and abdominal aorta appear normal.

Select Relevant Management
ACE Inhibitors
Diuretics
Renal replacement therapy
Early percutaneous balloon angioplasty