Editing Pediatrics: Anomalies of the Kidneys (section)

=== Renal Artery Aneurysm (RAAs) ===
* Overall incidence 0.1-0.3%
* '''Classified: saccular, fusiform, dissecting, and arteriovenous'''
** '''The saccular aneurysm,''' a localized outpouching that communicates with the arterial lumen by a narrow or wide opening, '''is the most common type'''
** When the aneurysm is '''located at the bifurcation of the main renal artery and its anterior and posterior divisions''', or at one of the more distal branchings, it is considered to be congenital in origin and is called the '''fusiform type'''
* Diagnosis and Evaluation
** History and Physical Exam
*** History
**** Most RAAs are silent, especially in children.
**** Many asymptomatic RAAs are diagnosed during an evaluation of hypertension
*** Physical Exam
**** Diagnosis is suspected when a pulsatile mass is palpated in the region of the renal hilum or when a bruit is heard on abdominal auscultation
** Imaging
*** A wreathlike calcification in the area of the renal artery or its branches (30%) is highly suggestive.
* '''Management'''
** '''Indications for intervention (7):'''
**# '''Rapidly expanding'''
**# '''Female and considering pregnancy''' (rupture during pregnancy is a likely possibility)
**# '''Renal artery aneurysm > 2.0cm''' (some sources say >2.5cm)
**# '''Symptoms (uncontrolled hypertension from renal artery stenosis, flank pain, hematuria)'''
**# '''Renal ischemia/infarction (resulting from embolization from the aneurysm)'''
**# '''Incomplete ringlike calcification is present'''
**# '''Arteriovenous fistula is present'''
** '''Options: endovascular vs. surgical repair'''
*** '''In young patients, surgical repair may be preferred as endovascular stent may require lifelong anti-coagulation'''