J Korean Soc Hypertens.  2013 Jun;19(2):63-69. 10.5646/jksh.2013.19.2.63.

A Case of Renovascular Hypertension Controlled by Renal Autotransplantation

• Lee E
• Kee YK
• Lee J
• Han IM
• Shin JI
• Kim MS
• Park S

• KMID: 1500274
• DOI: http://doi.org/10.5646/jksh.2013.19.2.63

Abstract

Renovascular hypertension caused by renal artery stenosis is an uncommon but curative cause of hypertension in children. We report a case of recurrent severe hypertension caused by renovascular hypertension. After recurrence of hypertension after redo percutaneous transluminal renal angioplasty, the blood pressure was finally controlled by renal autotransplantation. This case demonstrates the importance of considering renovascular hypertension as a cause of severe hypertension in children. Also, renal autotransplantation should be considered as a viable treatment option for treatment of renovascular hypertension that is recurrent after renal angioplasty.

Keyword

Renal artery; Hypertension; Transplantation; Renovascular hypertension

MeSH Terms

Angioplasty
Blood Pressure
Child
Humans
Hypertension
Hypertension, Renovascular*
Recurrence
Renal Artery
Renal Artery Obstruction
Transplantation*

Figure

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  Fig. 1. Kidney and adrenal magnetic resonance angiography. Right kidney shows small size and mid portion of renal artery is not delineated, suggestive of severe stenosis of right renal artery. Left kidney shows compensatory hypertrophy. Both adrenal glands show no remarkable finding.

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  Fig. 2. First percutaneous transluminal renal angioplasty. (A) Angiography revealed severe stenosis of right renal artery (B) Balloon angioplasty was done with 3.5 × 15 mm balloon at 6 atm/10 sec. Follow-up angiography revealed 60% residual stenosis with dissection. (C) Stent (Endeavor 4.0 × 18 mm) was inserted and inflated at 16 atm/10 sec. Follow-up angiography revealed that 30% of residual stenosis still remained. Adjuvant balloon angioplasty was done with balloon (4.0 × 18 mm) at 24 atm/10 sec. Final angiography revealed no residual stenosis.

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  Fig. 3. Changes in blood pressure with time. Blood pressure was decreased but increased again after first and second percutaneous transluminal renal angioplasty. Blood pressure was finally controlled after renal autotransplantation. ▴: percutaneous transluminal renal angioplasty. : renal autotransplantation.

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  Fig. 4. Renal doppler sonography. Right renal arterial flow showed wave form, suggesting re-stenosis. But peak systolic velocity (128 cm/sec) was equivocal.

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  Fig. 5. Renal doppler sonography. Slightly increased right renal artery velocity (peak systolic velocity, 185 cm/sec). Right distal renal artery was poorly delineated. No definite evidence of left renal artery stenosis.

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  Fig. 6. Second percutaneous transluminal renal angioplasty. (A) Right renal angiography revealed 90% restenosis of previously inserted stent. (B) Balloon angioplasty was done with 3.5 × 10 mm balloon at 24 atm/30 sec, several times. Follow-up angiography revealed 60% of residual stenosis without dissection. (C) Renal artery balloon angioplasty was done with Drug-Eluting Balloon (sequent please 3.5 × 20 mm) at 20 atm/1 min. Final angiography revealed less than 20% of residual stenosis without dissection.

Reference

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