Diagnosis Of Renal Artery Research Articles

Clinical characteristics and treatment of traumatic renal artery thrombosis

Objective To investigate the clinical characteristics, early diagnosis, and rational treatments of traumatic renal artery thrombosis or other traumatic emboli. Methods We summarized the clinical data of 10 patients with traumatic renal artery thrombosis or other traumatic emboli. Results Six of ten patients had left renal artery thrombosis, while four of the ten patients had right renal artery thrombosis.Ultrasonography reported a reduced blood flow signal in one patient, and then renal artery embolism was confirmed by enhanced CT.The other nine patients were directly definitely diagnosed as renal artery embolism by enhanced CT.Four patients were treated with low molecular weight heparin calcium, in whom the CT follow-up showed no obvious blood reperfusion in injured kidneys, but the renal function was in normal range.Renal hypertension occurred in two patients, and one of them received nephrectomy because of poorly controlled hypertension with medication. Conclusions Clinical symptoms, signs and laboratory examinations show no specific findings for diagnosis of traumatic renal artery thrombosis.The color Doppler ultrasound is a preliminary screening method for, and an enhanced CT scan is an effective method for, diagnosis of renal artery thrombosis.The early recovery of renal blood circulation is an evidence of effective treatment.Major concerns are supposed to focus on renal function and blood pressure during follow-up. Key words: Blunt injuries; Renal pedicle injury; Traumatic renal artery thrombosis

Stenoza de arteră renală de etiologie aterosclerotică – recurenţă chirurgicală pe rinichi unic la 12 ani după nefrectomie

Objectives. Renal artery stenosis, as main cause of renovascular secondary hypertension, is mainly caused by atherosclerosis of large vessels and is clinically characterized by resistant or malignant hypertension, impacting the kidney function to various degrees. The present article brings into attention the case of a patient which developed renal artery stenosis on the left kidney, the same condition occurring 12 years later on the right kidney. Material and method. Our patient was initially diagnosed at the age of 48 with complete occlusion of the left renal artery, for which left nephrectomy was performed, while the right artery was normal. Twelve years later she presents with renal artery stenosis on the right kidney, which is treat by stent-angioplasty. Results. After surgery, the patient’s evolution was positive, with amelioration of the laboratory values, in parallel to the arterial blood pressure. Discussions. The probability that, in the moment of diagnosis of renal artery stenosis with progressive evolution to occlusion caused by atherosclerosis, the other artery would be normal, both seen by ultrasonography and angiography, while years later to develop stenosis, is minimal. Up to present, the literature holds little evidence of such similar cases. Conclusions. In the particular case of patients that were diagnosed with severe renal artery stenosis of atherosclerotic origin and had only one of the arteries affected, it is necessary to keep a permanent monitoring, justified by the risk of development of the same pathology to the other artery

Color-coded duplex sonography in the diagnosis of renal artery stenosis—A 3-year experience in a large community hospital

From October 1991 to May 1995 we examined 1018 patients admitted for suspected renal artery stenoses. Of these, 229 consecutive patients (143 males and 86 females) were subjected to angiography. The mean age was 59 years (range 9–79 years). We used an Acuson 128 XP 10 duplex-unit with a 2/2.5-MHz sector probe. Color-coded tracings, pulsed-mode and continuous-mode Doppler readings were taken from the intra- and extrarenal arteries in order to define the velocity of the blood, to find spectral disturbances, and to calculate the resistive index (Pourcelot index) from these readings. In 85% of the patients a complete screening of the vessels was possible. The diagnosis of significant renal artery stenosis, i.e., a 60% reduction of diameter, was made when the maximal systolic velocity (Vmax) was above 1.60 m/second. In patients with Vmax between 1.20 and 1.60 m/second the diagnosis of a significant stenosis was made if spectral disturbances were present and a >40% reduced velocity was found elsewhere in the same main renal artery. With these criteria, color-coded duplex sonography (CCDS) in our 229 patients had a sensitivity and specificity of 86% and 96%, respectively. With an 83% prevalence of significant stenoses, the positive predictive value was 96%, the negative predictive value 83%. Forty-eight of the 67 accessory arteries to the kidney could be demonstrated by CCDS. We conclude that CCDS is an excellent screening tool to detect renal artery stenoses in the main renal arteries. Problems arise from stenosed accessory small vessels with hilar or polar destination which can be overlooked with CCDS. CCDS is indispensable for longitudinal follow-up of known renal artery stenoses and for control after angioplasty or operation for renovascular disease.

Renal vascular thrombolysis

The diagnosis of renal artery or venous thrombosis is difficult and often delayed. Even after thrombosis is identified, thromboylysis of the renal vasculature is rarely considered and infrequently performed. However, in selected patients, thrombolytic therapy can restore complete function. This article discusses arterial and venous thrombolytic strategies and results.

Color-coded duplex sonography in the diagnosis of renal artery stenosis—A 3-year experience in a large community hospital

Color-coded duplex sonography in the diagnosis of renal artery stenosis—A 3-year experience in a large community hospital

A prospective study of helical computed tomography angiography versus angiography for the detection of renal artery stenoses in hypertensive patients

To compare helical computed tomography angiography with arterial digital subtraction angiography in the diagnosis of renal artery stenoses. Fifty hypertensives (24 men; mean age 53 years) were prospectively studied with computed tomography (Somaton Plus S, Siemens) and digital angiography (double-blind evaluation). Computed tomography was performed both in the sequential (the length of the abdomen) and in the helical (6 cm around renal arteries) modes during injection of 120 cm3 contrast medium. Digital angiography visualized 16 significant (< 50% on quantitative angiography) stenoses (16/131 renal arteries, including 32 accessory), in 14 (28%) patients. On helical computed tomography, 16 stenoses were detected, in 49 patients (16/122 renal arteries, seven accessory arteries were not identified because they were located out side the scan area); two patients had false-positive helical computed tomography results. The computed tomography sensitivity, specificity, positive and negative predictive values were 87.5% (14/16), 98.2% (111/114), 87.5% and 98.2%, respectively. In the sequential mode, two cases of bilateral adrenal hyperplasia, two aortic aneurysms and one renal neoplasm were detected. None of these patients had renal artery stenosis. Helical computed tomography is a suitable new non-invasive diagnostic modality for the detection of renal artery stenosis or adrenal pathology. With continued development and evaluation computed tomography could prove useful as a screening tool or as a replacement for digital angiography in patients with possible secondary hypertension.