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.