Acute Severe Renal Artery Stenosis Presenting as Acute Kidney Injury with Severe Hypertension, and Active Urine Sediment

2021 ◽  
Author(s):  
Januvi Jegatheswaran ◽  
Adnan Hadziomerovic ◽  
Marcel Ruzicka
Keyword(s):  
Acute Kidney Injury ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Severe Hypertension ◽  
Kidney Injury ◽  
Artery Stenosis ◽  
Urine Sediment

scholarly journals P0251PERCUTANEOUS ANGIOPLASTY OF RENAL ARTERY STENOSIS IN PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING HEMODIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nabil Abu amer ◽  
Dganit Dinour
Keyword(s):  
Acute Kidney Injury ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Kidney Function ◽  
Kidney Injury ◽  
Artery Stenosis ◽  
Common Disease ◽  
Atherosclerotic Renal Artery Stenosis ◽  
Kidney Size

Abstract Background and Aims Atherosclerotic renal artery stenosis (RAS) is a common disease, associated with significant morbidity and mortality. Several studies have shown that percutaneous angioplasty with stenting (PTA/S) is not superior to medical treatment. The benefit of endovascular intervention among acute kidney injury (AKI) patients requiring hemodialysis secondary to RAS has not been studied. We investigated the effects of PTA/S in patients with atherosclerotic RAS, specifically those who presented with AKI indicated for hemodialysis. Method We collected data between 2003 and 2019. We defined a subgroup of patients who presented with AKI and underwent the procedure after starting hemodialysis. Data collected included demographic parameters, medical background, indication for intervention, technical procedure parameters and complications and long term data including dialysis treatment and mortality. Patients who underwent PTA/S due AKI with dialysis were categorized as responders or non-responders based on improvement in kidney function and weaning off dialysis. Results We identified 109 PTA/S performed in 92 patients. Technical success was 97% and complication rate was 15.5%. Creatinine and blood pressure improved in 8.9% and 32% respectively, based on predetermined criteria. A subgroup of 11 patients underwent PTA/S for hemodialysis-dependent AKI. 8 patients (73%) improved kidney function and discontinued dialysis. The average time on dialysis was 17 days (range 3-35 days) to PTA/S and 22 days (range 3-42 days) to recovery of kidney function, which occurred 6.5 days (range 1-24 days) after PTA/S. two of the 8 patients required long term hemodialysis after 12 and 22 months post procedure. Only two cases were reported with mild complications (pseudo-aneurysm and brachial hematoma). Factors associated with response to PTA/S include a higher baseline eGFR, less proteinuria, larger kidney size and better contrast enhancement on imaging. Conclusion In patients with hemodialysis dependent AKI, PTA/S should be considered as a rescue treatment and may recover kidney function even after prolonged time on dialysis.

Successful treatment of bilateral renal artery stenosis in a patient presenting with acute kidney injury

2021 ◽  
Vol 35 (2) ◽  
pp. 83
Author(s):  
Guliver Potsangbam ◽  
Gautam Thangjam ◽  
GurumayumSuman Kumar Sharma ◽  
Nongdrembi Rajkumari ◽  
Sumidra Laishram
Keyword(s):  
Acute Kidney Injury ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Successful Treatment ◽  
Kidney Injury ◽  
Artery Stenosis ◽  
Bilateral Renal Artery Stenosis ◽  
Bilateral Renal Artery

Renal artery stenosis

2015 ◽  
Author(s):  
James Ritchie ◽  
Darren Green ◽  
Constantina Chrysochou ◽  
Philip A. Kalra
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Acute Decompensated Heart Failure ◽  
Kidney Injury ◽  
Decompensated Heart Failure ◽  
Renal Tissue ◽  
Artery Stenosis ◽  
Atherosclerotic Renal Artery Stenosis ◽  
Clinical Criteria ◽  
Patients At Risk

Renovascular disease refers to a narrowing of a main or branch renal artery. Consequences include loss of functional renal tissue and renovascular hypertension, with other manifestations depending on the underlying cause. Worldwide the most common cause is atherosclerotic narrowing, with other causal pathologies including fibromuscular disease (FMD) and inflammatory conditions. FMD occurs much more frequently in women than in men, and is associated with smoking but genetic predisposing factors are also suspected. In South East Asia, Takayasu arteritis is an important cause.Takayasu disease often presents in a non-specific syndromic manner with fatigue and malaise. FMD often presents with early-onset hypertension. Atherosclerotic renal artery stenosis is often clinically silent with suspicion raised due to the existence of other cardiovascular pathology with the more dramatic presentations of acute decompensated heart failure or acute kidney injury less common. Clinical criteria can identify patients at risk.

scholarly journals Renal artery stenosis in a young female patient with severe hypertension - a case report

2019 ◽  
Vol 13 (3) ◽  
pp. 176-180
Author(s):  
Giuliano De Stefano ◽  
Federica De Pisapia ◽  
Giovanni Albano ◽  
Maria Immacolata Arnone ◽  
Giovanni Esposito ◽  
...  
Keyword(s):  
Case Report ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Severe Hypertension ◽  
Young Female ◽  
Secondary Hypertension ◽  
Artery Stenosis ◽  
Drug Eluting Stent ◽  
Hypertensive Patients ◽  
Drug Eluting

Renal artery stenosis is a frequent cause of secondary hypertension, but the diagnostic and therapeutic management of these hypertensive patients is controversial. We report a case of secondary hypertension due to renal artery stenosis, treated with the implantation of a drug-eluting stent.

scholarly journals Two Cases of Severe Hypertension in JAK2 Mutation-Positive Myeloproliferative Neoplasms

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Raunak Rao ◽  
Spoorthy Kulkarni ◽  
Ian B. Wilkinson
Keyword(s):  
Bone Marrow ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Bone Marrow Biopsy ◽  
Blood Count ◽  
Severe Hypertension ◽  
Myeloproliferative Neoplasms ◽  
Artery Stenosis ◽  
Full Blood Count ◽  
Jak2 Mutation

Background. Myeloproliferative neoplasms are a heterogeneous group of disorders resulting from the abnormal proliferation of one or more terminal myeloid cells—established complications include thrombosis and haemorrhagic events; however, there is limited evidence to suggest an association with arterial hypertension. Herein, we report two independent cases of severe hypertension in JAK2 mutation-positive myeloproliferative neoplasms. Case Presentations. Case 1: a 39-year-old male was referred to our specialist hypertension unit with high blood pressure (BP) (200/120 mmHg), erythromelalgia, and headaches. We recorded elevated serum creatinine levels (146 μM) and panmyelosis. Bone marrow biopsy confirmed JAK2-mutation-positive polycythaemia vera. Renal imaging revealed renal artery stenosis. Aspirin, long-acting nifedipine, interferon-alpha 2A, and renal artery angioplasty were employed in management. BP reached below target levels to an average of 119/88 mmHg. Renal parameters normalised gradually alongside BP. Case 2: a 45-year-old male presented with high BP (208/131 mmHg), acrocyanosis, (vasculitic) skin rashes, and nonhealing ulcers. Fundoscopy showed optic disc blurring in the left eye and full blood count revealed thrombocytosis. Bone marrow biopsy confirmed JAK2-mutation-positive essential thrombocytosis. No renal artery stenosis was found. Cardiac output was measured at 5 L/min using an inert gas rebreathing method, providing an estimated peripheral vascular resistance of 1840 dynes/s/cm5. BP was well-controlled (reaching 130/70 mmHg) with CCBs. Conclusions. These presentations highlight the utility of full blood count analysis in patients with severe hypertension. Hyperviscosity and constitutive JAK-STAT activation are amongst the proposed pathophysiology linking myeloproliferative neoplasms and hypertension. Further experimental and clinical research is necessary to identify and understand possible interactions between BP and myeloproliferative neoplasms.

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