A 66-year-old man whose renal function had progressively deteriorated had an elevated blood pressure and also was found to have an inflammatory abdominal aortic aneurysm (AAA). Blood examination revealed that he had eosinophilia. Livedo reticularis of the toes developed, and a skin biopsy specimen showed embolization of atheromatous plaques in the arterioles of the subcutaneous tissue. Progressive enlargement of inflammatory AAAmay have dislodged the atheromatous plaques, resulting in cholesterol embolism. (Internal Medicine 38: 861-864, 1999)
A 36-yr-old male was found to have renovascular hypertension due to an occluded right renal artery and 70% stenosis in the left renal artery, caused by fibromuscular dysplasia. The right kidney was supplied by collateral blood flow, and secreted more renin than the left kidney. Two differential therapeutic approaches were taken: autotransplantation for the right kidney and percutaneous transluminal renal angioplasty followed by stent implantation for the left. The renovascular hypertension was treated with these therapies, preserving renal function in this patient. (Hypertens Res 1999; 22: 141-143) Key Words: renovascular hypertension, fibromuscular dysplasia, autotransplantation, angioplasty, stentThree therapeutic options are currently available for patients with renovascular hypertension; medical antihypertensive therapy, surgical revascularization, and transluminal angioplasty including stent implantation. Percutaneous transluminal renal angioplasty (PTRA) has been widely used for renovascular hypertensive patients (1, 2), and more recently, intravascular stenting is reported to be potentially beneficial in improving the patency of dilated renal arteries (3, 4). In the meantime, surgical revascularization should be considered when these interventions cannot be used. We report here on a patient with bilateral renal arterial stenoses due to fibromuscular dysplasia (FMD), whose renovascular hypertension was treated with autotransplantation for the right kidney and PTRA followed by stent implantation for the left.Case Report A 36-yr-old male was referred to our hospital for elevated blood pressure accompanied by increased plasma renin activity (PRA) to 56 ng/ h/ ml. High blood pressure ranging from 160 to 170 mmHg at systole had been documented since the age of 20, but antihypertensive medicine was not administered until recently. Neither first-nor second-degree relatives had any similar diseases. On physical examination, his blood pressure was 164/110 mmHg with no difference between the two arms, despite antihypertensive treatment with 80 mg nifedipine and 20 mg arotinolol. The chest was clear of percussion and auscultation, and no bruit was audible in the abdomen.There were no abnormal findings in urinary or hematological examinations, and the blood chemistry data were all within normal limits, except for a reduced serum potassium concentration (3.1 mmol/ 1). The serum creatinine level was 0.7 mg/ dl and creatinine clearance was calculated at 65 ml/min. PRA was elevated to 15.1 ng/h/ml, and it further increased by 1,119% 1 h after 25 mg captopril administration, accompanied by reduction of mean blood pressure from 150 to 129 mmHg. Nothing remarkable was found by chest X ray, while SV1 + RV5 was 8.3 mV by electrocardiogram, suggesting left ventricular hypertrophy. A renogram showed a delayed peak of radioisotope uptake by the right kidney, whereas the pattern of the left was within normal limits ( Fig. 1-A). As shown in Fig. 2, abdominal aortography revealed total occlusion of the right renal artery and 70%...
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