A Case of Renovascular Hypertention. Segmental Hypoperfusion Resulting from Single Vessel Stenosis in the Presence of Bilateral Duplex Renal Arteries.

Abstract

A case of renovascular hypertension is presented with special emphasis on segmental hypoperfusion resulting from single vessel stenosis in the presence of bilateral duplex renal arteries. A forty-year-old male patient presenting with progressive elevation of blood pressure and proteinuria was admitted to our hospital for further evaluation. The elevation of plasma renin activity (PRA) was confirmed only after two-hour standing or under angiotensin converting enzyme inhibition with captopril. PRA obtained from the left renal vein was significantly higher than that from the right renal vein, and the angiogram disclosed bilateral duplex renal arteries and stenosis of 90% or more at the proximal portion in the left upper renal artery. Successful percutaneous transluminal renal angioplasty (PTRA) to the affected single renal artery resulted in normalization of the blood pressure and renin-angiotensin-aldosterone axis. This is the first clinical demonstration of renovascular hypertension resulting from segmental hypoperfusion of a unilateral kidney with lateralizing renal venous renin determination, that was successfully treated by revascularization.( Renovascular hypertension, which accounts for only 0.5% or less of hypertensive patients (1), is the most common curable form of secondary hypertension. Since multiple renal arteries are a relatively common variance and are present in approximately 20% of angiographically studied subjects (2), coexistence of these conditions conceivably may not be uncommon in the hypertensive population. Nonetheless, very few clinical cases of renovascular hypertension resulting from isolated stenosis in multiple renal arteries have been reported. This is probably related to diagnostic difficulties. We herein describe a case of renovascular hypertension resulting from critical stenosis of a single vessel in bilateral multiple renal arteries, which was identified by non-invasive tests and successfully treated by percutaneous transluminal renal angioplasty. Case ReportA forty-year-old male patient was admitted to our hospital presenting progressive hypertension and proteinuria. His blood pressure had been entirely normal until four months before admission, when a blood pressure of 1801100 mmHg and proteinurea were detected at an annual physical check-up. Upon admission, his blood pressure was 210/110 mmHg and heart rate was 48 bpm with normal sinus rhythm. Physical examination disclosed no particular abnormalities, including auscultatory findings of the heart or peripheral arterial pulsations. Funduscopic examination revealed no evidence of hypertensive neuroretinopathy.Neurological examination was essentially negative. Electrocardiogram showed terminal negative T waves in the left precordial leads. Echocardiogram and chest X-ray, however, did not reveal left ventricular hypertrophy or cardiomegaly. Urinalysis was within normal limits except for 2 + proteinuria. The protein content in a 24-h collection of urine was 1.3 g. Major findings in hematology and blood chemistry were within normal ...