Captopril DMSA Contribution in the Identification of the Cause of Severe Hypertension in an Otherwise Healthy 5-Year-Old Girl

Hypertension in younger children is usually secondary to various disorders. A previously healthy 5-year-old girl was diagnosed with stage 2 hypertension. Her personal and family history was noncontributory, and she was normal on physical examination. Blood tests revealed a strongly elevated renin and slightly increased aldosterone, suggesting a renovascular cause. Nevertheless, color Doppler ultrasound, CT, and MR angiography were normal. A DMSA renal scan with and without captopril was performed with results suggestive of a right intrarenal segmental artery branch stenosis, which was corrected with arteriography. A captopril DMSA can be helpful in localizing smaller intrarenal artery branch stenoses.