Renovascular hypertension in infant presenting with cardiogenic shock.

A 35-day-old infant admitted with cardiogenic shock was hypertensive shortly after initial resuscitation therapy. The hypertension did not respond to increasing doses of sodium nitroprusside. An abnormal blood flow in the right renal artery was detected by pulsed Doppler ultrasonography, and a prompt blood pressure response to oral captopril suggested a diagnosis of renovascular disease. Renal angiography showed right main renal artery stenosis, abnormal intrarenal arteries, and nonfunctional right kidney; the patient subsequently underwent right nephrectomy with good effect. Myocardial dysfunction resolved 2 months after control of the blood pressure.