Renovascular hypertension secondary to renal artery compression by diaphragmatic crura

Mirza, Aleem K.; Kendrick, Michael L.; Bower, Thomas C.; DeMartino, Randall R.

doi:10.1016/j.jvscit.2020.03.002

Cited by 8 publications

(2 citation statements)

References 12 publications

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“…RVH can be caused by renal artery compression by extrinsic masses, e.g., Wilms' tumor, neuroblastoma, renal cysts, or diaphragmatic crura [8,26]. To the best of our knowledge, this is the first reported case of RVH caused by renal artery displacement and compression by dysfunctive urinary bladder.…”

Section: Discussionmentioning

confidence: 87%

An unusual cause of renovascular hypertension in a pediatric patient with chronic kidney disease

Skrzypczyk

Kanclerz

Ostrowska

et al. 2022

Arterial Hypertension

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Background: Renovascular hypertension (RVH) accounts for 5-10% of arterial hypertension in children and is most commonly caused by fibromuscular dysplasia. Sporadically, renal artery stenosis in pediatric patients is caused by extrinsic compressive masses. Case report: A 12-year-old patient with complex urinary tract defect (dysplastic left kidney -nephrectomy at 11 months, right ectopic kidney in the midline, behind the urinary bladder), chronic kidney disease (CKD) stage 2, and arterial hypertension was admitted to the hospital due to worsening of kidney function during angiotensin-converting enzyme inhibitor (ACE-I) therapy. CT angiography revealed a right ectopic kidney located above the bladder, supplied by a single renal artery originating from the right common iliac artery. The renal artery had a tortuous shape with width in the ostium approx. 4.5 mm; then, the artery was bent and ran between the common iliac artery and the kidney. Ultrasound performed with a filled bladder showed bending and stenosis of the renal artery at the origin from the right common iliac -peak systolic velocity (PSV) 4.5-5.5 m/s and renal-aortic ratio (RAR) 3.1. With an empty bladder, no bending or stenosis was visible (PSV 1.7-1.9 m/s and RAR 1.0). Uroflowmetry revealed a dysfunctional micturition curve, large bladder capacity, and post-void urine retention. ACE-I was changed to beta-blocker and doxazosin, which led to blood pressure and kidney function normalization. Conclusions: Renal ectopia associated with bladder dysfunction may result in renal artery stenosis causing renovascular hypertension.

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Section: Discussionmentioning

confidence: 87%

An unusual cause of renovascular hypertension in a pediatric patient with chronic kidney disease

Skrzypczyk

Kanclerz

Ostrowska

et al. 2022

Arterial Hypertension

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“…Due to its rarity, literature describing hypertension secondary to diaphragmatic compression on the renal vessels is limited, with only 23 cases reported by a recent review. The review also showed that among cases reported, almost 48% (11) had left-sided compression, almost 17% (4) had right-sided compression, 13% (3) cases were bilateral, and the rest were unknown [ 7 ]. Our patient had a right-sided renal artery indentation by the diaphragmatic crus.…”

Section: Discussionmentioning

confidence: 99%

Renovascular Compression by the Diaphragmatic Crus: A Case Report

Al-Smair¹,

Saadeh²,

Saadeh³

et al. 2022

Cureus

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Renovascular hypertension (RVHT) is among the most prevalent causes of treatment-resistant hypertension. Mostly it is caused by renal artery stenosis (RAS). With atherosclerosis being the most common cause of RAS, RAS due to external compression by the diaphragmatic crus is rare. The treatment of rare causes requires individualization due to the differences between their etiologies. Herein, we present a case of an 18-year-old patient presenting with high blood pressure readings. On follow-up, he was diagnosed with hypertension. On further evaluation, the right diaphragmatic crus compressed the right renal artery. This case emphasizes medical management in patients with hypertension secondary to diaphragmatic crus compression, and radiological findings in such cases.

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