Stenting of a renal artery compressed by the diaphragm

Urology & Nephrology Open Access Journal, 2018

BMJ, 1968

Journal of Medical Case Reports

Background: Secondary hypertension accounts for 5% of all cases of hypertension. Renal artery stenosis is one of the common causes of secondary hypertension. Atherosclerosis and fibromuscular dysplasia are the commonest types of stenosis associated with renal vascular hypertension, with the former accounting for 70-80% of all cases and the latter accounting for 10% of the incidence. The greatest incidence atherosclerosis is in men over the age of 40 years, mostly affecting the proximal part of the renal arteries, whereas fibromuscular dysplasia affects women ranging in age from 30 to 50 years. Currently, possible treatments are medical treatment using blood pressurelowering drugs, balloon angioplasty with or without stent insertion, and surgery to reconstruct the artery. Case presentation: We report a case of a 46-year-old Asian woman with stenosis of two branches of renal artery bifurcation treated by percutaneous balloon dilatation and stenting of both branches after referral to our department for a renal angiogram following 8 months of uncontrolled hypertension despite receiving medications. Initially, the patient presented with severe headache and fatigue. She was a known nonsmoker, was not diabetic, and had no history of diabetes in her family. She had no history of atherosclerosis. Apart from high blood pressure, the result of her physical examination was unremarkable. Laboratory investigations revealed normal serum cholesterol, lipid profile, and serum creatinine. She had been attending a hypertension clinic and receiving antihypertensive drugs for the past 8 months on a regular basis under close observation. Despite this treatment and care, her blood pressure remained high at 175/110 mmHg, which the attending doctor concluded to be uncontrolled blood pressure. Initial imaging indicated left renal artery stenosis, and the patient was referred to our department. Conclusions: For patients with uncontrolled hypertension despite receiving medications, renal Doppler ultrasound should be included in the diagnostic workup for secondary hypertension. Once renal artery stenosis is suspected, renal angiography is highly recommended because the technique is able to accurately diagnose stenosis in the branch arteries, unlike computed tomographic angiography and magnetic resonance angiography. Percutaneous transluminal renal angioplasty is the treatment of choice for renal artery stenosis in patients with renovascular hypertension or renal dysfunction.

Journal of the American College of Cardiology, 2004

The Journal of Clinical Hypertension, 2014

The Lancet, 1958

A case of a 12-year-old boy with renal artery stenosis as a cause of hypertension is presented. The diagnosis of renal artery stenosis was established based on the bruit heard over costovertebral angle and the increased plasma renin secretion, and further confirmed by angiogram finding. The detection of bruit, either on the abdomen or costovertebral angle, in association with hypertension should initially lead to the consideration of the presence of renal artel)' stenosis.

Nephrology Dialysis Transplantation

Background and Aims Renal artery stenosis (RAS) is present from 1% to 5% in people affected by arterial hypertension and it is often associated with peripheral artery disease and coronary artery disease; as the matter of fact, it is commonly found in people undergoing cardiac catheterization (18-20%) or angiography for aorto-iliac and lower extremities diseases. The major cause of renal artery stenosis is an atherosclerotic lesion localized in the proximal segment or to the ostium. Clinical presentations are renovascular hypertension and ischemic nephropathy. The aim of the study is to define either endovascular treatment gives a significant benefit on renal function and blood pressure control, when associated to medical therapy. Method This is a retrospective study focused on patients who underwent renal artery angioplasty and stenting in the last ten years, from November 2011 to April 2021 in the Nephrology Department, at Sant'Andrea Hospital, La Spezia (Italy). The primary ou...

Case Reports, 2014

American Journal of Roentgenology, 1981

International Journal of Research in Medical Sciences

Renal artery stenosis (RAS) is a major contributor to the prevalence of secondary hypertension. Fibromuscular dysplasia and atherosclerosis are commonly responsible for the occurrence of the disease. Medical therapy is the primary means of treatment for RAS. However, surgical interventions for revascularization are also considered, in selected group of patients, which can effectively cure hypertension and chronic kidney disease. An older man presented at Venus hospital, Surat, Gujarat with the complaints of severe dyspnea, edema, uncontrolled hypertension and renal insufficiency. He was diagnosed RAS and was operatively managed with percutaneous transluminal renal angioplasty. Written consent was taken from the patient mentioned in the study. During the procedure, the renal artery got ruptured, which was managed by placing a covered stent. The patient was successfully treated for RAS, in spite of comorbidities and intraoperative complication. In the subsequent clinical follow-up, th...