scholarly journals Endovascular management of an unsual case of spontaneous Retroperitoneal Haemorrhage due to Fibromuscular Dysplasia

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Juan David Molina-Nuevo ◽  
Lorena López-Martínez ◽  
María José Pedrosa-Jiménez ◽  
Enrique Juliá-Molla
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Fibromuscular Dysplasia ◽  
Treatment Options ◽  
Favourable Outcome ◽  
Left Renal Artery ◽  
Retroperitoneal Haematoma ◽  
Renal Angioplasty ◽  
Left Hypochondrium ◽  
Retroperitoneal Haemorrhage

Abstract Background Fibromuscular dysplasia (FMD) is an uncommon vascular disease that results in stenosis, dissection or aneurysmal degeneration. However, it can sometimes manifest atypically, as we show in this case. Case presentation A 24-year old patient with no relevant medical history with severe left hypochondrium pain. The physical examination showed blood pressure levels of 160/90 mmHg. An abdominopelvic CT evidenced left retroperitoneal haematoma associated with active bleeding and left renal artery stenosis. Given these findings, it was decided to perform an endovascular treatment. Significant stenosis was seen during the arteriography in both renal arteries, suggesting fibromuscular dysplasia and development of a collateral neovascular network responsible for the retroperitoneal haematoma. It was embolised in association with angioplasty of the left renal artery. The patient had a favourable outcome; however, high blood pressure levels persisted. A new bilateral renal angioplasty was performed, which returned blood pressure values to normal. The patient was discharged without needing antihypertensives. Conclusions FMD is a rare disease that can show multiple clinical presentations and need individualized treatment options. Endovascular techniques are in the first therapeutic line regarding fibromuscular dysplasia.

scholarly journals Detection of significant left renal artery stenosis caused by fibromuscular dysplasia with selective angiography

2020 ◽  
Vol 91 (4) ◽  
pp. 269-271
Author(s):  
Ramezan Jafari ◽  
Zohreh Rostami ◽  
Mohammad Nikpoor ◽  
Mohammad Javanbakht ◽  
Mohsen Sadeghi Ghahroudi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Fibromuscular Dysplasia ◽  
Good Control ◽  
Proximal Part ◽  
Computed Tomographic Angiography ◽  
Left Renal Artery ◽  
Computed Tomographic ◽  
History Of ◽  
The Right

A 22-year-old female, was referred with a history of a headache and elevated blood pressure without family history of hypertension or familial dyslipidemia. Initially, a spiral computed tomographic angiography of the renal arteries was conducted, demonstrating completely abnormal left renal artery at the medial portion of the vessel with suspicious stenosis, which was supposed to be due to fibromuscular dysplasia (FMD). Subsequently, the patient underwent selective renal angiography and balloon angioplasty. Severe stenosis was observed on the left side and moderate stenosis on the right side in the medial and proximal part of the vessels, respectively. After the diagnosis of FMD, the left side was treated by balloon and finally, the patient was discharged with good control of blood pressure by losartan/amlodipine treatment.

scholarly journals Revascularization in a 17-Year-Old Girl with Neurofibromatosis and Severe Hypertension Caused by Renal Artery Stenosis

2017 ◽  
Vol 44 (1) ◽  
pp. 50-54
Author(s):  
Carmen C. Beladan ◽  
Oliviana D. Geavlete ◽  
Simona Botezatu ◽  
Marin Postu ◽  
Bogdan A. Popescu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Neurofibromatosis Type 1 ◽  
Severe Hypertension ◽  
Neurofibromatosis Type ◽  
Artery Stenosis ◽  
Left Renal Artery ◽  
Renal Angioplasty

Renal artery stenosis caused by neurofibromatosis is a rare cause of renovascular hypertension. This hypertension can develop during childhood and is one of the leading causes of poor outcome. We report the case of a 17-year-old girl who was incidentally diagnosed with severe hypertension. During her examination for secondary hypertension, we reached a diagnosis of neurofibromatosis type 1 on the basis of a cluster of typical findings: optic nerve glioma, café au lait spots, nodular neurofibromas, and axillary freckling. Renal angiograms revealed a hemodynamically significant left renal artery stenosis (70%). Renal angioplasty with a self-expanding stent was performed one month later for rapidly progressive renal artery stenosis (90%) and uncontrolled blood pressure. Excellent blood pressure control resulted immediately and was maintained as of the 2-year follow-up evaluation. We think that percutaneous transluminal renal angioplasty can be effective in select patients who have neurofibromatosis type 1 and refractory hypertension caused by renal artery stenosis.

scholarly journals Unilateral renal sympathetic denervation may reduce blood pressure in patients with refractory hypertension

2015 ◽  
Vol 9 (4) ◽  
pp. 362
Author(s):  
Aurelio Negro ◽  
Rosaria Santi ◽  
Antonio Manari ◽  
Franco Perazzoli
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Renal Denervation ◽  
Antihypertensive Drugs ◽  
Renal Sympathetic Denervation ◽  
Caucasian Woman ◽  
Left Renal Artery ◽  
Refractory Hypertension ◽  
The Mean

A 52-year-old Caucasian woman with essential resistant and refractory hypertension despite optimal medical therapy, including 6 different antihypertensive drugs was referred for the catheter-based renal denervation. Due to unfavourable anatomy because of non-critical fibromuscular dysplasia on the right renal artery, renal denervation of only the left renal artery was performed. Before and after the renal denervation, the patient’s blood pressure was monitored by <em>office</em> measurements and ambulatory blood pressure measurements (ABPM). Before the procedure, the mean <em>office</em> blood pressure was 157/98 mmHg; at ABPM, the mean blood pressure values were 145/94 mmHg. At 6 months of follow-up, the mean <em>office</em> blood pressure was 134/90 mmHg and 121/76 mmHg at ABPM. In latest 12 months of follow-up, <em>office</em> and ABPM blood pressure were 125/80 and 127/80 mmHg respectively. This unique case suggests that unilateral renal denervation may be effective in lowering blood pressure in patients with refractory hypertension and unfavorable renal arteries anatomy.

Chemical Renal Medullectomy; Effect upon Reversal of Two-Kidney, One-Clip Hypertension in the Rat

1981 ◽  
Vol 61 (s7) ◽  
pp. 335s-338s ◽  
Author(s):  
R. F. Bing ◽  
G. I. Russell ◽  
J. D. Swales ◽  
H. Thurston ◽  
A. Fletcher
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Urine Volume ◽  
Renal Medulla ◽  
Plasma Renin ◽  
Left Renal Artery ◽  
Hypertensive Rats ◽  
Plasma Renin Concentration ◽  
Complete Reversal ◽  
Renal Artery Constriction

1. Chemical renal medullectomy was produced in rats by injection of 2-bromoethylamine hydrobromide. Plasma creatinine and blood pressure were unchanged although urine volume was increased fourfold. 2. Left renal artery constriction resulted in similar degrees of hypertension in both intact and medullectomized rats. This was associated with a significantly smaller rise in plasma renin concentration in the latter. 3. Blood pressure in conscious intact hypertensive rats became normal within 24 h of unclipping whereas blood pressure of medullectomized rats remained significantly elevated. 4. The presence of an intact renal medulla is essential to the complete reversal of two-kidney, one-clip hypertension in the rat. This may reflect the loss of a medullary vasodepressor system.

scholarly journals MON-LB043 A Case of Renovascular Hypertension With Cortisol-Producing Adrenal Masses

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Takuya Higashitani ◽  
Daisuke Aono ◽  
Mitsuhiro Kometani ◽  
Shigehiro Karashima ◽  
Masashi Demura ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Renal Artery ◽  
Renovascular Hypertension ◽  
Plasma Glucose ◽  
Left Renal Artery ◽  
Glucose Levels ◽  
Computed Tomography Scanning ◽  
Old Japanese ◽  
Adrenal Masses

Abstract Renovascular hypertension (RVHT) is an important and potentially treatable form of resistant hypertension. Hypercortisolemia could also cause hypertension and diabetes mellitus. We experienced a case wherein adrenalectomy markedly improved blood pressure and plasma glucose levels in a patient with RVHT and subclinical Cushing’s syndrome. A 62-year-old Japanese man had been treated for hypertension and diabetes mellitus for 10 years. He was hospitalized because of disturbance in consciousness. His blood pressure (BP) was 236/118 mmHg; pulse rate, 132 beats/min; and plasma glucose level, 712 mg/dl. Abdominal computed tomography scanning revealed the presence of bilateral adrenal masses and left atrophic kidney. Abdominal magnetic resonance angiography demonstrated marked stenosis of the left main renal artery. The patient was subsequently diagnosed with atherosclerotic RVHT with left renal artery stenosis. Bilateral adrenal masses were immunohistologically identified as potential sites for cortisol overproduction. Therefore, laparoscopic left nephrectomy and adrenalectomy were simultaneously performed resulting in improved BP and glucose levels. Pathological studies revealed the presence of multiple cortisol-producing adrenal nodules and aldosterone-producing cell clusters in the adjacent left adrenal cortex. In the present case, activated renin-angiotensin-aldosterone system and cortisol overproduction resulted in severe hypertension, which was managed with simultaneous unilateral nephrectomy and adrenalectomy.

Effect of Percutaneous Transluminal Renal Angioplasty on Absolute Split Renal Function in Patients with Renovascular Hypertension. Influence of Age and Other Parameters

1993 ◽  
Vol 60 (1) ◽  
pp. 27-33
Author(s):  
M. Takeda ◽  
Y. Katayama ◽  
K. Saito ◽  
T. Tsutsui ◽  
T. Komeyama ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Plasma Renin ◽  
Artery Stenosis ◽  
Renal Angioplasty ◽  
Split Renal Function ◽  
Percutaneous Transluminal Renal Angioplasty ◽  
Percutaneous Transluminal

Tc99m-dimercaptosuccinic acid renal uptake (DMSA uptake) was examined to assess the changes in split renal function following percutaneous transluminal renal angioplasty (PTRA) in 9 patients with a total of 12 renal artery stenoses and renovascular hypertension (RVH). The results were studied with respect to age, degree of renal artery stenosis, and renal vein renin ratio (RVRR) before PTRA. Although the degree of renal artery stenosis, systolic blood pressure, and peripheral blood plasma renin activity were improved 3 months after PTRA, neither the DMSA uptake of the affected kidneys nor that of the contralateral kidneys improved. Although restenosis occurred during the long follow-up period in one patient, DMSA uptake did not change in parallel with the degree of stenosis or RVRR. The degree of improvement in DMSA uptake, blood pressure, and plasma renin activity after PTRA in patients aged under 70 years was significantly higher than that in patients 70 years or older. Good improvement of renal function was attained in a 4-year-old boy, despite the fact that split renal function prior to PTRA was so poor that nephrectomy had been considered instead of PTRA. These results suggest that several factors before PTRA, such as DMSA uptake, degree of renal artery stenosis, and RVRR, are not absolutely predictive of results after PTRA, and that the effect of PTRA on blood pressure and renal function is greater in younger patients.

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