Abstract: Objective To investigate the early diagnostic methods for renovascular hypertension(RVH) in children. Methods Children diagnosed as RVH in Peking University First Hospital from January 1996 to July 2011 were included. The data including early diagnosis and treatment, age, gender, clinical characteristics and imaging examination results were collected and analyzed retrospectively. Results Totally 29 children diagnosed as RVH were included aged from 0.5 to 15 years with a mean age of 7 years. There were 18 boys and 11 girls. The duration of diagnosis ranged from 15 days to 7 years, the average duration was 11 months. Nine children (31.0%) were diagnosed half year after some misdiagnosis such as gastritis, epilepsy, renal and cardiac diseases. Hypertension was found in 3 children due to convulsion after fluid injection. The most common onset symptoms included headache (34.5%), vomiting (34.5%), and convulsion (31.0%). The mean blood pressure was 182/127mmHg. Twenty five children were diagnosed as unilateral renal vascular stenosis and 4 children were diagnosed as bilateral renal vascular stenosis. Twenty three children were diagnosed by renal arterial angiography, 4 children were diagnosed by renal arterial ultrasound examination, 1 child was diagnosed by renal arterial ultrasound examination combined with computed tomography, 1 child was diagnosed by renal arterial ultrasound examination and MRA. Among the children diagnosed by renal angiography, the difference in bilateral renal size exceeded 1.5 cm in 10/17 children. The renal arterial ultrasound and CT examination detected 31.3%(5/16) and half (3/6) renal vascular hypertension respectively. Renography examination showed that 93.8% (15/16) of children with RVH had compromised renal function. Elevated serum renin and angiotensin were seen in 88.9%(16/18) patients. Hypokalemia was observed in 41.4% (12/29) of them. Ten children (34.5%) were diagnosed as Takayasu disease, 3 of them received nephrectomy, and 2 relapsed. Conclusions The misdiagnosis of RVH patients was common. Blood pressure should be monitored for children with symptoms of headache, vomiting and convulsion especially before fluid injection. Renography was a sensitive method for detection of compromised renal function. For children with hypertension, renal ultrasound could be used as a screening tool. The difference of bilateral renal size exceeding 1.5 cm deserved further investigation of RVH. High serum renin and angiotensin and hypokalemia had suggestive roles for RVH. Renal arterial ultrasound and CT examinations were not sensitive enough. For children who were suspected as RVH, renal arterial angiography should be performed as early as possible. Etiology diagnosis should be made especially for Takayasu arteritis.