Keywords: Pediatric, Renovascular, Hypertension, Evolution, Medicine
Abstract
Though pediatric renal artery stenosis (RAS) is the most common cause of
secondary hypertension in children, it is uncommon. Interestingly,
geographic variance of disease etiology has been reported in the
literature. Fibromuscular dysplasia (FMD) contributes to most pediatric
RAS cases in Europe and North America while Takayasu arteritis (TA) is
the main cause in Asia. The high prevalence of essential hypertension
observed in African Americans has been well-documented, in which there
may be latitude dependent genes that once protected ancestors from
dehydration but became maladaptive in modern, salt heavy environments.
However, a review of the literature yielded little information that
could support a latitudinal association with the aforementioned
geographic variance concerning the different etiologies contributing to
pediatric RAS. Upon further exploration, the ACE insertion/deletion (ACE
I/D) polymorphism surfaced as a possible link between FMD and TA when considering renovascular disease in children. The ACE I allele is
associated with greater endurance in whites while the D allele may
provide this advantage to Asians, suggesting that endurance and
increased susceptibility to pediatric RAS may be involved an
evolutionary tradeoff. This preliminary discussion may eventually guide future
research efforts concerning identification of gene patterns and perhaps
lead to development of earlier treatment.