Idiopathic retroperitoneal fibrosis with particular perirenal and intrarenal extension associated with left renal artery stenosis. The atheromatous periaortitis with retroperitoneal fibrosis suggests a pathogenic relationship between atherosclerosis and fibrosis?

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

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Refractory hypertension secondary to renal artery stenosis with a honeycomb-like structure

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02428-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Cheng Chen ◽

Ying Zhang ◽

Da Yin ◽

Yan Liu ◽

Yunpeng Cheng ◽

...

Keyword(s):

Renal Artery ◽

Renal Artery Stenosis ◽

Fibrous Tissue ◽

Honeycomb Structure ◽

Artery Stenosis ◽

Proximal Segment ◽

Left Renal Artery ◽

Renal Infarction ◽

Refractory Hypertension ◽

Spider Web

Abstract Background A honeycomb-like structure (HLS) is a rare abnormality characterized by a braid-like appearance. Angiograph and intravascular examination, including coherence tomography and intravascular ultrasound (IVUS), can further confirm the multiple intraluminal channels or honeycomb structure, which can also be described as looking like ‘swiss cheese’, a ‘spider web’ or a ‘lotus root’. Previous studies have mostly reported this abnormality in coronary arteries, with a few cases in renal arteries. More information about the characteristics and development of HLS is needed. Case presentation A 69-year-old Han man with resistant hypertension received abdominal enhanced computerised tomography and was revealed to have left renal artery stenosis with the possibility of left renal infarction. Renal artery angiography confirmed a 95% stenosis located in the proximal segment of the left renal artery, and the middle segment was blurred with multi-channel-like blood flow. Further IVUS was performed and identified multiple channels surrounded by fibrous tissue. It was a rare case of HLS in the renal artery secondary to the thrombus, with organisation and recanalisation. Balloon dilatation and stent implantation at the proximal segment of the left renal artery were performed successfully. Blood pressure was well controlled after the procedure. Conclusions The IVUS findings are helpful for forming interventional therapeutic strategies for HLS lesions in the renal artery.

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Thoracolumbar Junction Syndrome Accompanying Renal Artery Stenosis: A Case Repor

Annals of Rehabilitation Medicine ◽

10.5535/arm.2020.44.1.85 ◽

2020 ◽

Vol 44 (1) ◽

pp. 85-89

Author(s):

Kyudong Noh ◽

Jong Burm Jung ◽

Jeong Won Seong ◽

Doh-Eui Kim ◽

Dongrak Kwon ◽

...

Keyword(s):

Renal Artery ◽

Renal Artery Stenosis ◽

Correct Diagnosis ◽

Flank Pain ◽

Artery Stenosis ◽

Common Reason ◽

Thoracolumbar Junction ◽

Left Renal Artery ◽

Paravertebral Muscles ◽

Minor Improvement

Flank pain is a common reason for visits to the emergency room. The most common reason warranting hospital visits are urology-related problems. However, there are many other causes, such as musculoskeletal lesions, that difficult to achieve a correct diagnosis. Here, we describe a rare case of flank pain caused by thoracolumbar junction syndrome, accompanying renal artery stenosis. A 54-year-old male with hypertension presented with severe left flank pain for 1 week. Initially, he was diagnosed with left renal artery stenosis by computed tomography and decreased renal function on renal scan (Tc-99m DTPA). Although a stent was inserted into the left renal artery, flank pain persisted with only minor improvement. Through detailed physical examination, he was finally diagnosed with thoracolumbar junction syndrome. After three injections in the left deep paravertebral muscles at the T10–T12 levels, flank pain completely ceased. Clinicians must consider thoracolumbar junction syndrome, when treating patients with flank pain.

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Use of shockwave intravascular lithotripsy for the treatment of calcified renal artery stenosis in a symptomatic subject

Future Cardiology ◽

10.2217/fca-2019-0051 ◽

2020 ◽

Vol 16 (5) ◽

pp. 419-423

Author(s):

S Schnupp ◽

I Ajmi ◽

M Sinani ◽

J Brachmann ◽

C Mahnkopf

Keyword(s):

Renal Artery ◽

Renal Artery Stenosis ◽

Artery Stenosis ◽

Left Renal Artery ◽

Shockwave Lithotripsy ◽

Refractory Hypertension ◽

Atherosclerotic Renal Artery Stenosis ◽

Wall Apposition ◽

The Right ◽

Symptomatic Subject

Aim: The use of shockwave lithotripsy for the treatment of heavily calcified atherosclerotic plaques before stenting showed great results in terms of feasibility and safety with favorable initial success. Evidence suggests that it is a useful tool to treat calcified lesions in peripheral and coronary arteries. Here, we describe the case of a patient with calcified renal artery stenosis successfully treated with the shockwave lithotripsy system. Case Report: We present a 76-year-old man with a known significant atherosclerotic renal artery stenosis and refractory hypertension. The patient received an angioplasty of the right renal artery in the first session and he was admitted for a second session to intervene in the left renal artery. The lesion was successfully treated with the lithotripsy system. Final angiography demonstrated an excellent position of the stent and good wall apposition. Conclusion: Our clinical case demonstrates that lithotripsy is safe and effective also for the treatment of the renal artery.

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Stenosis-dependent role of nitric oxide and prostaglandins in chronic renal ischemia

AJP Renal Physiology ◽

10.1152/ajprenal.00012.2001 ◽

2002 ◽

Vol 282 (5) ◽

pp. F859-F865 ◽

Cited By ~ 13

Author(s):

Hirobumi Tokuyama ◽

Koichi Hayashi ◽

Hiroto Matsuda ◽

Eiji Kubota ◽

Masanori Honda ◽

...

Keyword(s):

Nitric Oxide ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Renal Plasma Flow ◽

Renal Hemodynamics ◽

Renal Ischemia ◽

Artery Stenosis ◽

Left Renal Artery ◽

Severe Stenosis

The role of nitric oxide (NO) and prostaglandins (PG) in modifying renal hemodynamics was examined in clipped and nonclipped kidneys of unilateral renal artery stenosis. Chronic unilateral renal ischemia was established by 4-wk-clipping the left renal artery of canine kidneys, and renal interstitial nitrate+nitrite and PGE2 contents were evaluated by the microdialysis technique. Unilateral renal artery stenosis caused 45 ± 1 and 73 ± 1% decrements in renal plasma flow (RPF) in moderately and severely clipped kidneys and 21 ± 3% decrements in nonclipped kidneys with severe stenosis. Renal nitrate+nitrite decreased in moderately (−31 ± 1%) and severely clipped kidneys (−63 ± 4%). N ω-nitro-l-arginine methyl ester reduced RPF (−56 ± 3%) and glomerular filtration rate (GFR; −54 ± 3%) in moderately clipped kidneys, whereas this inhibitory effect was abolished in severely clipped kidneys. In contrast, renal PGE2 contents increased modestly in moderate clipping and were markedly elevated in severely clipped kidneys (from 111 ± 7 to 377 ± 22 pg/ml); sulpyrine impaired renal hemodynamics only in severely clipped kidneys. In contralateral nonclipped kidneys, although renal PGE2 was not increased, sulpyrine reduced RPF (−32 ± 1%) and GFR (−33 ± 3%) in severe stenosis. Collectively, NO plays a substantial role in maintaining renal hemodynamics both under basal condition and in moderate renal artery stenosis, whereas the contributory role shifts from NO to PG as renal artery stenosis progresses. Furthermore, because intrarenal angiotensin II is reported to increase in nonclipped kidneys, unilateral severe ischemia may render the nonclipped kidney susceptible to PG inhibition.

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Case report of secondary hypertension due to renal artery stenosis in young patient

Medical Journal of Indonesia ◽

10.13181/mji.v23i2.666 ◽

2014 ◽

Vol 23 (2) ◽

pp. 117-21

Author(s):

Wendy M. Saragih ◽

Siska Sulistiowati ◽

Nur Haryono ◽

Bambang B. Siswanto ◽

Nani Hersunarti ◽

...

Keyword(s):

Case Report ◽

Renal Artery ◽

Young Patient ◽

Renal Artery Stenosis ◽

Secondary Hypertension ◽

Artery Stenosis ◽

Left Renal Artery ◽

Bilateral Renal Artery Stenosis ◽

Bilateral Renal Artery ◽

Percutaneous Transluminal Angiography

Secondary hypertension is rare to occur, but should become suspicion in young age. Secondary hypertension must be appropriately diagnosed and treated. Renal artery stenosis is one of many causes of secondary hypertension. The aim of this case report is to describe diagnosis, pathophysiology and management of secondary hypertension due to renal artery stenosis in young patient. A 17 year old man with symptom of shortness of breath was diagnosed with hypertension stage 3 on his medical examination at Pasar Rebo Hospital, Jakarta. Abdominal CT scan examination revealed bilateral renal artery stenosis. Percutaneous transluminal angiography (PTA) of left renal artery was performed at National Cardiovascular Centre Harapan Kita. Stent was placed succesfully and the blood pressure was normalized.

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CXCL16 regulates renal injury and fibrosis in experimental renal artery stenosis

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00948.2015 ◽

2016 ◽

Vol 311 (3) ◽

pp. H815-H821 ◽

Cited By ~ 12

Author(s):

Zhiheng Ma ◽

Xiaogao Jin ◽

Liqun He ◽

Yanlin Wang

Keyword(s):

Blood Pressure ◽

Bone Marrow ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Knockout Mice ◽

Renal Injury ◽

Critical Role ◽

Artery Stenosis ◽

Left Renal Artery ◽

Wild Type

Recent studies have shown that inflammation plays a critical role in the initiation and progression of hypertensive kidney disease, including renal artery stenosis. However, the signaling mechanisms underlying the induction of inflammation are poorly understood. We found that CXCL16 was induced in the kidney in a murine model of renal artery stenosis. To determine whether CXCL16 is involved in renal injury and fibrosis, wild-type and CXCL16 knockout mice were subjected to renal artery stenosis induced by placing a cuff on the left renal artery. Wild-type and CXCL16 knockout mice had comparable blood pressure at baseline. Renal artery stenosis caused an increase in blood pressure that was similar between wild-type and CXCL16 knockout mice. CXCL16 knockout mice were protected from RAS-induced renal injury and fibrosis. CXCL16 deficiency suppressed bone marrow-derived fibroblast accumulation and myofibroblast formation in the stenotic kidneys, which was associated with less expression of extracellular matrix proteins. Furthermore, CXCL16 deficiency inhibited infiltration of F4/80+ macrophages and CD3+ T cells in the stenotic kidneys compared with those of wild-type mice. Taken together, our results indicate that CXCL16 plays a pivotal role in the pathogenesis of renal artery stenosis-induced renal injury and fibrosis through regulation of bone marrow-derived fibroblast accumulation and macrophage and T-cell infiltration.

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AB0530 CHARACTERISTICS AND MEDIUM-TERM OUTCOMES OF TAKAYASU ARTERITIS–RELATED RENAL ARTERY STENOSIS: ANALYSIS OF A LARGE CHINESE COHORT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3427 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1562.2-1562

Author(s):

Y. Sun ◽

X. Dai ◽

P. LV ◽

Z. Dong ◽

J. Lin ◽

...

Keyword(s):

Renal Insufficiency ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Takayasu Arteritis ◽

Adverse Outcomes ◽

Artery Stenosis ◽

Left Renal Artery ◽

Preoperative Treatment ◽

Medium Term ◽

Chinese Cohort

Background:The incidence of renal artery stenosis in Takayasu arteritis (TA) was 20%–60% according to previous reports. The specific characteristics of patients with TA-related renal artery stenosis and the effect of revascularization procedures on prognosis have not been fully investigated.Objectives:To investigate the characteristics of patients with TA-related renal artery stenosis and identify the predictors of medium-term adverse outcomes.Methods:Data for 567 patients registered in a large prospective observational cohort-the East China Takayasu arteritis cohort-up to April 30, 2019, were retrospectively analyzed.Results:Renal artery stenosis was confirmed in 172/567 (30.34%) patients, with left renal artery involvement seen in 73/172 (42.44%) patients. Renal insufficiency at presentation (HR = 2.37, 95% CI: 1.76-15.83, p = 0.03), bilateral renal artery involvement (HR = 6.95, 95% CI: 1.18-21.55, p = 0.01), and severe (>75%) stenosis (HR = 4.75, 95% CI 1.08-11.33, p = 0.05) were predictors of adverse outcomes. Revascularization was performed for 46/172 (26.74%) patients. Patients without preoperative treatment had higher rate of restenosis (44.44% vs. 15.79%, p < 0.01) and hypertension deterioration (25.93% vs. 10.53%, p < 0.01) after the procedure. Non-receipt of preoperative treatment (HR = 6.5, 95% CI: 1.77-32.98, p = 0.04) and active disease at revascularization (HR = 4.21, 95% CI 2.01-21.44, p = 0.04) were independent predictors of adverse outcomes after revascularization.Conclusion:Patients with uncontrolled or worsening hypertension or/and renal function may benefit from revascularization. Those who have received preoperative treatment may have more favorable revascularization outcomes. Prognosis appears to be poorer for patients with renal insufficiency at presentation, bilateral artery involvement, and severe stenosis.References:[1]Watanabe Y, Miyata T, Tanemoto K. Current clinical features of new patients with Takayasu arteritis observed from a cross-country research in Japan: age and sex specificity. Circulation 2015; 132: 1701-9.[2]Peng M, Jiang XJ, Dong H, et al. Etiology of renal artery stenosis in 2047 patients: a single-center retrospective analysis during a 15-year period in China. J Hum Hypertens 2016; 30: 124-8Disclosure of Interests:None declared

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