Background: Renal artery stenosis (RAS) and mid-aortic syndrome (MAS) are significant yet under-recognized causes of pediatric hypertension. RAS is characterized by the narrowing of the renal arteries, while MAS involves the stenosis of the abdominal aorta along with its associated vessels. The etiologies of RAS and MAS often involve genetic factors and acquired conditions such as fibromuscular dysplasia and Takayasu arteritis, contributing to their complex clinical presentations. Despite advancements in diagnostic imaging, challenges remain in effectively identifying these conditions. Pharmacological treatment can achieve partial blood pressure control, but it usually does not lead to complete recovery. Treatment options range from angioplasty to more definitive surgical interventions such as renal artery reimplantation and aorto-aortic bypass, tailored according to the specific pathology and extent of the disease. Methods: This review explores the diagnosis and management of RAS and MAS in children, highlighting the necessity for early detection and showcasing the evolving landscape of treatment. Conclusions: We advocate for a multidisciplinary approach that includes advanced imaging for effective diagnosis and tailored therapy. By integrating the latest research and clinical practices, this article provides valuable insights into managing complex vascular conditions in the pediatric population, ultimately aiming to enhance the quality of life for affected individuals.

Around 15% of pregnancies develop complications requiring detailed monitoring. With technological advancements, home cardiotocography has emerged as a potential alternative to the conventional approach, aiming to alleviate the stress and logistical challenges associated with in-clinic care. The objective of this study was to evaluate the capability of a portable device to collect data for accurate interpretation of the examination and to evaluate patient satisfaction, along with physical and emotional comfort during the monitoring process. This retrospective study included 32 women with high-risk pregnancies, who independently performed 581 examinations utilizing the portable cardiotocography device Pregnabit Pro (Nestmedic, Poland). Moreover, participants were asked to provide feedback on their experiences through a comprehensive survey. In total, 95.7% of examinations successfully captured all necessary diagnostic data. Patients reported a high satisfaction rate, recognizing the potential of the home-based approach to improve their overall pregnancy experience. A preference for home-based testing over in-clinic visits was consistently noted among patients. This study shows evidence that home cardiotocography is a feasible and patient-preferred method for monitoring high-risk pregnancies. Our findings underline the importance of technological integration in prenatal care, advocating for a shift toward more patient-centered, accessible, and potentially cost-effective health care solutions.

BACKGROUND Arterial hypertension in pediatric patients often presents complex diagnostic and therapeutic challenges. The diagnosis of hypertension in children is based on different guidelines than in adults, with arterial hypertension in children defined as systolic and/or diastolic blood pressure values at or above the 95th percentile for age, sex, and height. Unlike adult populations, it is predominantly secondary in etiology, with conditions such as renovascular hypertension as common causes. Fibromuscular dysplasia and Takayasu arteritis are frequent underlying causes of renal artery stenosis associated with this patient population. CASE REPORT This case report details the successful management of a 15-year-old girl with severe symptomatic hypertension. Plasma renin and aldosterone concentration analysis, Doppler ultrasonography, and angiography were crucial in assessing the severity and nature of the renal stenosis, leading to a diagnosis of renovascular hypertension associated with fibromuscular dysplasia. The patient underwent 2 successful percutaneous transluminal renal angioplasties, achieving blood pressure control without the need for long-term pharmacological therapy. CONCLUSIONS In children with elevated blood pressure, secondary hypertension should always be considered and investigated. The diagnosis of renal artery stenosis necessitates a multidisciplinary approach, combining laboratory tests and invasive and non-invasive imaging techniques. Ultrasound is often insufficient for comprehensive and detailed imaging of the renal arteries, being susceptible to error. Careful and comprehensive management of similar cases in specialized centers is essential for ensuring optimal patient care.

Arterial hypertension (AH) affects 4% of children, with the most common etiologies including renal parenchymal disease, renovascular abnormalities, and primary hypertension. Severe hypertension in a patient with a urinary tract defect is a rare conjunction, requiring investigation for other coexisting pathologies. We present the case of a 4-year-old boy with bedwetting, daytime urinary incontinence, and an episode of urinary tract infection, which led to an extensive diagnostic evaluation. The workup revealed bilateral vesicoureteral reflux, posterior urethral valves (PUV), suspected focal lesions in the left kidney, and stenosis of a branch of the right renal artery due to fibromuscular dysplasia. Initially, he required multidrug antihypertensive therapy, and coiling of the narrowed artery resulted in a significant improvement in blood pressure control. The urological conditions required pharmacotherapy for incontinence and an endoscopic transection of PUV. Currently, he remains on ramipril, desmopressin, and mirabegron, with good control of hypertension and urinary incontinence, normal renal function, and no recurrent urinary tract infections. We present a unique case of a complex urinary tract defect with associated fibromuscular dysplasia treated with renal artery branch coiling. This combination of conditions is exceptionally uncommon, with only isolated reports in the literature describing such an approach. This case demonstrates the need for multidisciplinary management of children with hypertension and urinary symptoms. What initially appeared to be a straightforward urinary tract infection with bladder dysfunction evolved into a multifaceted clinical scenario requiring a combination of pharmacological management and staged interventional treatment.

In this case series we present the cases of two patients at a metastatic stage of stomach gastrointestinal stromal tumor, who received treatment with imatinib. After a period of disease stability patients showed signs of resistance to the first-line therapy and despite the promising switch to sunitinib, developed life-threatening complications. Salvage surgeries were performed, aimed at preserving patients life and simultaneously reducing the tumor mass. Operation greatly improved patients condition and allowed for successful continuation of tyrosine kinase inhibitor treatment, showing that surgery should be considered a viable complement to the chemotherapeutical treatment. In this case series we present the cases of two patients at a metastatic stage of stomach gastrointestinal stromal tumor, who received treatment with imatinib. After a period of disease stability patients showed signs of resistance to the first-line therapy and despite the promising switch to sunitinib, developed life-threatening complications. Salvage surgeries were performed, aimed at preserving patients life and simultaneously reducing the tumor mass. Operation greatly improved patients condition and allowed for successful continuation of tyrosine kinase inhibitor treatment, showing that surgery should be considered a viable complement to the chemotherapeutical treatment.

We describe a case of a 3-year-old girl with neurofibromatosis type 1 presenting with arterial hypertension, in whom multimodal vascular imaging identified significant right renal artery stenosis. The patient was successfully treated with percutaneous transluminal renal angioplasty; however, post-procedural Doppler ultrasound revealed a transient vascular fistula. Changes in renal arterial inflow during the procedure may have temporarily altered pressure gradients, facilitating the opening of communication involving pre-existing compensatory collateral vessels. This case illustrates the diagnostic value of multimodal vascular imaging in pediatric hypertension and highlights a rare, self-limiting post-interventional vascular phenomenon.