Impaired weight gain and renovascular hypertension.

An eight month old infant was admitted to hospital because of poor weight gain. During the hospitalization she became unconscious and had convulsions. On these occasions a high blood pressure (205/120 mm Hg) was measured. In further evaluation of the hypertension, high plasma renin activity (32.8 ug/l/h) with a high serum aldosterone concentration (13000 pmol/l) was measured. Because of these findings renal angiography was performed: this revealed a stenosis of the left renal artery. A reconstruction of the renal artery was performed by a microsurgical technique and nine months after the operation the child was only mildly hypertensive but still required antihypertensive medication (propranolol 10 x 3, hydralazine 5 mg x 2): with this treatment her blood pressure was 110/80 mm Hg. After the operation her weight rose from below 2.5 percentile to the 10th percentile. The importance of blood pressure measurement in all children and infants admitted to hospital, regardless of their symptoms, is stressed.