Case Of Renovascular Hypertension Research Articles

Genetics of renovascular hypertension in children.

In most cases of renovascular hypertension in children, the cause is unclear. The aim of this study was to investigate genetic variation as a factor in the development of renovascular hypertension in children. In a cohort of 37 unrelated children from a single tertiary referral center, exome sequencing was performed. We assessed variants in recognized and suspected disease genes and searched for novel ones with a gene-based variant-burden analysis. In the majority of patients, exome sequencing could not identify causative variants. We found a pathogenic variant in a recognized associated disease gene in five patients (three pathogenic variants in NF1, one in ELN and a deletion of chromosome 7q11.23, consistent with Williams syndrome). In two other patients, (likely) pathogenic variants were found in putative renovascular hypertension genes (SMAD6 and GLA), with clinical implications for both. Ten additional patients carried variants of uncertain significance (VUS) in known (n = 4) or putative (n = 6) renovascular hypertension disease genes. Rare variant burden analysis yielded no further candidate genes. Genetic contributors, such as germline mutations in NF1, ELN, 7q11.23del were present in only 5 out of 37 (14%) children with renovascular hypertension. Twelve other children (32%) had potentially causal variants identified, including a pathogenic variant in SMAD6; a vasculopathy gene hitherto unknown to link with renovascular hypertension. Most importantly, our data show that exome sequencing can rarely identify the cause of renovascular hypertension in nonsyndromic children. We suggest that nongenetic factors or somatic genetic variation will play a more important role.

Renovascular Hypertension

Renovascular hypertension is now a curable disease in most cases by interventional radiological techniques. The authors reviewed diagnostic and therapeutic aspects of renovascular hypertension, focusing on practical points, and introduced several cases of renovascular hypertension, treated by surgery or interventional radiological techniques.

潰瘍性大腸炎に合併した腎血管性高血圧の1 例

潰瘍性大腸炎に合併した腎血管性高血圧の1 例

A case of renovascular hypertension with mild hyperreninemia and normoaldosteronemia diagnosed by renovascular ultrasonography

A case of renovascular hypertension with mild hyperreninemia and normoaldosteronemia diagnosed by renovascular ultrasonography

A Case of Renovascular Hypertension Controlled by Renal Autotransplantation

A Case of Renovascular Hypertension Controlled by Renal Autotransplantation

Moyamoya Disease with Renal Artery and External Iliac Artery Stenosis

Moyamoya disease is a rare, progressive occlusive disease of the cerebral vasculature, mainly involving internal carotid and proximal cerebral arteries with development of fine collateral vascular network in brain. Coexistence of renal vascular lesion with cerebral vascular lesion has rarely described and association with external iliac and femoral vascular stenosis is not known to the best of our knowledge. This is the first case of renovascular hypertension with Moyamoya disease being reported in India with involvement of other extra cranial vessels.

Renal autotransplantation in the treatment of hypertension and uraemia due to renal artery stenosis

Four cases of renovascular hypertension cured or improved by renal autotransplantation are described. In one case correction of renal ischaemia resulted in an improvement of renal function. Previous reports of this technique are reviewed and the limitations of the more standard operation of saphenous vein bypass graft are discussed.

An unusual case of renovascular hypertension–renal artery stenosis of a pelvic kidney with aberrant blood supply

An unusual case of renovascular hypertension–renal artery stenosis of a pelvic kidney with aberrant blood supply

Cutting balloon angioplasty of resistant renal artery stenosis caused by fibromuscular dysplasia

Balloon angioplasty is an established intervention to treat renovascular hypertension. Conventional balloon angioplasty is usually effective in cases of renovascular hypertension caused by fibromuscular dysplasia. In the present report, we describe two cases of renovascular hypertension caused by fibromuscular dysplasia in which stenotic lesions were resistant to conventional balloon angioplasty but were successfully managed by a cutting balloon. After cutting balloon angioplasty, systemic blood pressure was normalized in both patients, without the use of antihypertensive agents. Angioplasty by using a cutting balloon is a new therapeutic choice against renal artery stenosis that is resistant to dilation by a conventional balloon.

Renovaskuläre Hypertonie

Atherosclerotic renal artery stenosis accounts for most cases of renovascular hypertension (RVH). Hypertensive patients with clinical features suggesting RVH should be submitted to further noninvasive evaluation including duplex Doppler ultrasonography, CT- or MR angiography. Invasive evaluation by contrast-enhanced angiography confirms the diagnosis of renal artery stenosis. However, neither diagnostic test reliably predicts the course of hypertension after revascularisation. The therapeutic approach in hypertensive patients with hemodynamically important renal artery stenosis includes medical or invasive therapy (renal percutaneous transluminal angioplasty, PTRA; renal arterial stent placement, PTRAS; surgical revascularisation). Randomized trials comparing invasive and conservative approaches demonstrated no differences in blood pressure control or renal function. Only patients with clear clinical indications should be submitted to interventional procedures as PTRA, PTRAS and surgical vascular intervention.

A case of renovascular hypertension due to Takayasu’s arteritis associated with systemic lupus erythematosus in a man

A case of renovascular hypertension due to Takayasu’s arteritis associated with systemic lupus erythematosus in a man

Two Cases of Renovascular Hypertension and Ischemic Renal Dysfunction: Reliable Choice of Examinations and Treatments

We experienced two aged patients with atherosclerotic renovascular stenosis associated with hypertension and ischemic nephropathy. Both patients exhibited sudden rise in blood pressure (BP) and progressive aggravation of renal dysfunction. In these patients, the use of contrast medium to screen for renal artery stenosis (RAS) ran the risk of further deterioration of renal function. We therefore used magnetic resonance angiography (MRA), which is less conducive to renal damage, to screen for RAS. One-sided RAS was treated by percutaneous transluminal angioplasty of the renal artery (PTRA) and stenting. As a result, BP decreased in both patients. Serum creatinine (Cr) decreased slightly in one patient, whereas, in the other, serum Cr increased transiently and then decreased and stabilized to pre-treatment levels. Thus, although it is unclear whether the combination of PTRA and stenting is among the best treatments for patients with RAS and moderate-to-severe renal dysfunction, PTRA and stenting are clearly of benefit in selected patients. In addition, recent progress in characterizing the pathophysiology of ischemic nephropathy associated with renovascular hypertension has created interest in the therapeutic potential of angiotensin II receptor antagonists, sympatholytic agents, and antioxidants. Therefore, we discuss the therapeutic utility of PTRA and stenting and the above-mentioned medications in patients with RAS and renal dysfunction.

Reno-vascular hypertension treated with percutaneous transluminal angioplasty

Eighty seven cases of reno-vascular hypertension were treated with percutaneous transluminal angioplasty (PTA) between October 1981 and October 1997. Athrosclerosis was the etiology of renal artery lesions in 14 cases (16.1%), arthritis in 65 cases (74.7%), and fibromuscular dysplasia (FMD) in 8 cases (9.2%). There were 116 renal arteries suffered. Unilateral disease was in 48 cases, bilateral was in 39 cases. Average length of stenostic segment was 9.0 ± 5.75 mm (mean ± SD) before PTA, the wide was 1.81 ± 0.99 mm, after PTA, the average wide was 3.95 ± 1.29 mm. The systolic blood pressure was 198 ± 34 mmHg, diastolic was 124 ± 23 mmHg before treatment. At the follow-up period, 51 (1–168) months, the systolic blood pressure was 144 ± 15 mmHg, and diastolic pressure was 93 ± 13 mmHg. The morbidity rate in this series was 8% (one false aneurysm at the puncture site, one renal artery dissection, two renal artery thrombosed, and three bleeding at the puncture site). There was no mortality. The cure-improve rate in athrosclerosis cases was 57.1%, in arteritis cases was 81.6%, FMD was 87.5%. The conclusion was PTA should be considered as the first choice for the treatment of renovascular hypertension, especially for the arthritis patients.

Reno-vascular hypertension treated with percutaneous transluminal angioplasty

Eighty seven cases of reno-vascular hypertension were treated with percutaneous transluminal angioplasty (PTA) between October 1981 and October 1997. Athrosclerosis was the etiology of renal artery lesions in 14 cases (16.1%), arthritis in 65 cases (74.7%), and fibromuscular dysplasia (FMD) in 8 cases (9.2%). There were 116 renal arteries suffered. Unilateral disease was in 48 cases, bilateral was in 39 cases. Average length of stenostic segment was 9.0 ± 5.75 mm (mean ± SD) before PTA, the wide was 1.81 ± 0.99 mm, after PTA, the average wide was 3.95 ± 1.29 mm. The systolic blood pressure was 198 ± 34 mmHg, diastolic was 124 ± 23 mmHg before treatment. At the follow-up period, 51 (1–168) months, the systolic blood pressure was 144 ± 15 mmHg, and diastolic pressure was 93 ± 13 mmHg. The morbidity rate in this series was 8% (one false aneurysm at the puncture site, one renal artery dissection, two renal artery thrombosed, and three bleeding at the puncture site). There was no mortality. The cure-improve rate in athrosclerosis cases was 57.1%, in arteritis cases was 81.6%, FMD was 87.5%. The conclusion was PTA should be considered as the first choice for the treatment of renovascular hypertension, especially for the arthritis patients.

Ambulatory blood pressure during diseases of the kidney

During the last few years there has been a renewal of interest in blood-pressure-induced kidney damage due to a progressive increase in the incidence and prevalence of hypertension and vascular diseases as a cause of end-stage renal disease (ESRD). The need to prevent ESRD demands a continuation of effort to make the early identification of hypertensives who are at risk possible and to provide them with effective antihypertensive therapy. Since ambulatory blood pressure monitoring has been used successfully to assess blood pressure and identify risk markers for cardiovascular diseases, a logical approach would be to use it also to identify the risk markers for ESRD. Higher than normal percentages of non-dippers have been found among subjects with renal failure, during dialysis (haemofiltration, peritoneal dialysis and continuous ambulatory peritoneal dialysis), among cases of renovascular hypertension or cystic kidney disease and among cases of renal transplantation. Although this non-dipping pattern might be related to the presence of severe hypertension in some patients, such as those who have renovascular hypertension, in other cases the abnormal circadian variability is present with milder forms of hypertension or even in the absence of hypertension. Monitoring ambulatory blood pressure could offer advantages for protection of renal function during antihypertensive treatment of subjects with mild renal insufficiency. Furthermore, ambulatory blood pressure monitoring seems to have been prognostic for the development of proteinuria in a group of refractory hypertensives. Whether higher than normal nocturnal blood pressures and the non-dipping pattern are causes or consequences of renal disease should be addressed in prospective studies. The above notwithstanding, assessment of nocturnal blood pressure seems to be an important aid in the management of patients with hypertension-related renal disease and of patients who are susceptible to developing it.

Diagnosis of renal artery branch stenosis using captopril intervention scintirenography.

A case of renovascular hypertension in a young male is presented. The patient had a small size right kidney with reduced differential function on the baseline [99mTc]-DTPA renal study. Captopril intervention scintigraphy demonstrated a dramatic reduction in renal perfusion and cortical uptake in the upper and mid-poles of the affected kidney. Time-activity curves of the [99mTc]-DTPA studies using segmental regions of interest corroborated visual findings. The presence of renal artery branch stenosis was confirmed on renal angiography.

A case of renovascular hypertension with normal plasma renin activity at rest in which diagnosis was established by the captopril test

A case of renovascular hypertension with normal plasma renin activity at rest in which diagnosis was established by the captopril test

A Case of Renovascular Hypertension Associated with Neurofibromatosis

We report a case of renovascular hypertension associated with neurofibromatosis complicated by moderate proteinuria. A 16-year-old female was admitted to Kensei General Hospital with a complaint of headache and a blood pressure of 230/120 mm Hg. She was referred to us for further evaluation of the hypertension. On examination, cafe-au-lait spots were seen over her extremities and flank, and a bruit was heard in the right upper abdomen. The urinary protein excretion was 2.1 g/day. The plasma renin activity (PRA) and plasma aldosterone concentration were high, but the levels of catecholamines were normal. The renogram was asymmetric and on venous sampling, the PRA in the right renal vein was 58.3 ng/ml/h and that in the left was 22.1 ng/ml/h. CT scan detected an approximately 10-mm mass in the proximal right renal artery. Arteriography disclosed severe stenosis in the right renal artery and the superior mesenteric artery. Therefore, we concluded that her hypertension resulted from stenosis of the right renal artery due to neurofibromatosis. Accordingly, she underwent an operation to reconstruct that artery. After the operation, her blood pressure and PRA normalized without administration of any anti-hypertensive drug and urinary protein disappeared.

A case of renovascular hypertension with interesting changes of transmitral and pulmonary venous flow velocity patterns

A case of renovascular hypertension with interesting changes of transmitral and pulmonary venous flow velocity patterns

Renovascular Hypertension Induced by Localized Renal Ischemia due to Obstruction of Supplemental Artery of Double Renal Arteries and Collateral Blood Flow in the Left Kidney.

A case of renovascular hypertension with localized ischemia in the left kidney is described. The captopril test and renography showed a pattern typical of renin-dependent unilateral renovascular hypertension. However, renal arteriography did not show stenosis of the renal artery. Enhanced and dynamic computed tomography revealed ischemia in the dorsal portion of the left kidney and an aortic dissection with thrombosis, suggesting obstruction of the supplemental renal artery of double renal arteries. The localized renal ischemia was attributed to insufficient blood supply from the main renal artery to the obstructed area.(Hypertens Res 1993; 16: 221-224)