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Vascular complications after renal transplantation are the most frequent type of complication following urological complications. They may affect the function of the transplant. Early vascular complications include renal artery or vein thrombosis, lesions to the iliac vessels and cortical necrosis. Delayed complications mainly include renal artery stenosis, arteriovenous fistula, and rarely false aneurysm. Doppler sonography, sometimes with the use of intravenous contrast, is the imaging modality of choice in the acute setting or routine follow-up. MRI may be performed for additional morphological and functional evaluation while CT may provide additional evaluation of the arterial supply. Angiography is performed prior to endovascular treatment., (Copyright © 2011 Elsevier Masson SAS and Éditions françaises de radiologie. All rights reserved.)

The authors report the experience of the Children's Hospital of Marseille about ten renal transplantations in nine children. Indications, immunosuppressive treatment, surgical techniques employed are detailed. The results study show two mains complications : rejection and arterial hypertension. A better recipient selection, as in adults, would increase good results.

The case of a young boy developing hypertension 3 years after removal of a small kidney due to pyelonephritis and vesico-ureteral reflux. Discovery in the artery of the remaining kidney of a limited coarctation without any of the lesions usually responsible for hypertension. Cured by enlargement angioplasty with a 5 year follow-up. This case is interpreted as an example (to our knowledge the only case in the literature) of hypertension, the mechanism of which is that revealed by Schlegel's experiments.

Renovascular hypertension in a 15-years-old girl, originating in a lower pole aberrant renal artery stenosis by fibromuscular hyperplasia. Microsurgical management by polar artery reimplantation in the renal artery. Unknown evolutivity and diffusion of arterial dysplasias explain the more and more distal repairs reported in literature concerned with renovascular hypertension in infancy and childhood. Nephrectomy and segmental resection are now only done when revascularization is not possible.

Dissecting aneurysms of the renal artery are the most common site of peripheral dissections without aortic involvement. The problems posed by this condition are analysed in the light of a personal cases and 52 in the literature. The onset in a young man of sudden loin pain followed shortly after by hypertension is suggestive of obstruction of a renal artery. The diagnosis can be confirmed only by arteriography, if the findings are sufficiently clearcut, which is not invariably the case. Surgical treatment gives good results and our own case clearly indicates the immediate and definitive relief of hypertension by nephrectomy. However the decision regarding surgery must take into account the possibility of recurrent peripheral lesions and of the possible reversibility of hypertension under the influence of medical treatment.

The authors report a case of hypertension due to dysplasia of the renal arteries in a young man, and found the same disease in siblings. Two sisters and one brother also had renal hypertension, whereas the other relatives were unaffected. Two similar cases found in the world literature, did not permit the authors to determine the cause of this disease. This case is reported in order to stimulate research and the discovery of new cases.

The authors present 5 cases of restorative surgery of the renal artery in the child. Four gave an immediate and lasting excellent result, with return of the arterial blood pressure to normal in the absence of any post-operative medical hypotensive treatment.

We have studied the effects of intravenous infusion of saralasin, a competitive antagonist of angiotensin II, in 27 hypertensive patients: 13 had essential hypertension, 14 had renal lesions which involved the renal artery in 9 cases. In essential hypertensives saralasin administration did not significantly lower blood pressure, even after mild salt depletion. It induced a decrease in blood pressure in 7 patients with renal abnormalities (5 with renal artery stenosis, 2 with unilateral parenchymal disease). It may be suggested that in these cases hypertension was dependent, at least partly, on the renin-angiotensin system. In agreement with other investigators, we have found a relationship between the level of plasma renin activity and the blood pressure decrease obtained by saralasin. In patients with unilateral renal artery stenosis, blood pressure decrease was related to renal vein ratio of plasma renin activity.

A boy of two years has an hematuria which was first related with an hypertensive acute glomerulonephritis. However because of recurrency of the hematuria radiological investigations were performed and a solid tumor of the right kidney was discovered. The arterial hypertension regressed after the right nephrectomy. Pathology demonstrated a tumor of Grawitz which is rare in children and which is seldom associated with an arterial hypertension. We found only five similar cases in the literature. Arterial hypertension can be related either with a compression of the renal artery of with an inadequate secretion of renin by the tumor.

One hundred and eight patients suffering from hypertension due to a unilateral parenchymatous neophropathy were studied over a period of one to eight years after treatment was starded. The aetiologies were diverse: harmonious hypoplasia, segmental hypoplasia, pyelonephritis, reflux nephropathy, hydronephrosis and tuberculosis. Thirty nine patients were treated surgically, with 50% good results. In 82 cases medical treatment was continued for at least a year with a 52% success rate. Such success was recorded in 94% of cases in which beta-blockers were used (38 cases). Surgical success was not dependent upon the period for which hypertension had been present. The best results were seen in cases of hydronephrosis and pyelonephritis and the worst in tuberculosis. Thirteen patients underwent surgery event though there was no unilateral increase in plasma renin levels. Seven were improved or cured. Ten patients underwent surgery with a renin activity 50% greater than on the healthy side, 9 being improved or cured. Treatment with beta-blockers, alone or in association with diuretics, controlled blood pressure in 90% of cases, regardless of the renin activity. Plasma renin activity in the renal veins is of good prognostic value in terms of the effectiveness of nephrectomy against hypertension. In Call cases, beta-blockers were more effective than surgery.

On the basis of a clinical case, the authors review the principal signs of Bourneville tuberose sclerosis and show the renal manifestations which may be encountered. The most common is the presence in both kidneys of tumours which are hamartomas. In addition, this patient suffered from hypertension and renal insufficiency. Their frequency and pathogenesis are discussed in the context of this disease.

During aetiological investigation of recently developed hypertension in a 31-year-old man, isolated dissection of the upper branch of the right renal artery was discovered. Injection, after sodium depletion, of saralasin, a competitive angiotensin II inhibitor, resulted in significant fall of the mean arterial pressure. During sodium depletion, the plasma renin activity was higher in the right renal artery (17.8 ng/ml/h) than in the left artery (9.4 ng/ml/h) and the infra-renal portion of the inferior vena cava (8.7 ng/ml/h). These figures suggested that surgical treatment of the dissection would have beneficial effects on blood pressure. Six months after resection of the pathological arterial segment and replacement by a graft from the internal saphenous vein, blood pressure had spontaneously returned to normal levels.