scholarly journals Retrospective Study of Renal Artery Doppler evaluation of Hypertensive patients

2018 ◽  
Vol 6 (1-2) ◽  
pp. 1-5
Author(s):  
Sharma Paudel ◽  
Ram Kumar Ghimire ◽  
Om Biju Panta ◽  
Ashbina Pokharel
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Resistance Index ◽  
Study Data ◽  
Artery Stenosis ◽  
Doppler Studies ◽  
Accessory Renal Artery ◽  
Imaging Center ◽  
Experienced Radiologist ◽  
Doppler Study

Introduction: Doppler study is a good screening test for initial screening of renal artery stenosis however controversies exists regarding its use as screening study. This study aims to evaluate the Doppler study findings in patients with atypical hypertension.Methods: The study was a retrospective hospital record based study conducted in Metro Radiological and Imaging Center, Kathmandu. Reports of Doppler studies performed for atypical hypertension were reviewed for the duration of 6 years (2009 to 2014). Doppler studies were performed by two experienced radiologist with more than 5 and 20 years of experience. Patients with transplant kidney, patient with accessory renal artery and patient with known chronic kidney disease were excluded from the study. Data was entered in predesigned proforma and analysis was done with SPSS 21.0.Results: A total of 1001 Doppler studies done during the study period revealed abnormalities in 227 patients. The most common abnormality was elevation of main renal artery and lobar renal artery resistance index, alone which was seen in 187(82.4%) patients. Renal artery stenosis was noted in 30(13.2%) cases with 10 patients each having renal artery stenosis involving left and right renal arteries respectively and 10 patients had bilateral renal artery stenosis.Conclusion: Non-specific raised resistance index indicating renal impairment is the most common abnormality in atypical hypertensives. The presence of renal artery stenosis in atypical hypertensive is around 3%.

scholarly journals Intrarenal Color Doppler Ultrasonography in the Diagnosis of Accessory Renal Artery Stenosis

2013 ◽  
Vol 2 (2) ◽  
pp. 59-64
Author(s):  
RK Rauniyar ◽  
DN Srivastava ◽  
CS Bal ◽  
SC Dash ◽  
M Berry
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Doppler Ultrasonography ◽  
Color Doppler ◽  
Accurate Method ◽  
Color Doppler Ultrasonography ◽  
Artery Stenosis ◽  
Lower Pole ◽  
Accessory Renal Artery ◽  
Acceleration Time

Conventional color Doppler ultrasonography of main renal artery is a valuable non invasive tool in screening and diagnosing patients with renal artery stenosis. However, this technique suffer a set back from many limitations. Color Doppler ultrasonography examination of intrarenal branch arteries using the parameters like, acceleration time, acceleration time ratio, and acceleration index with additional sampling from upper and lower pole of kidney has shown good results in diagnosis of renal artery stenosis. We successfully diagnosed accessory renal artery stenosis in two patients using intrarenal Doppler technique. We conclude, intra renal Color Doppler ultrasonography with additional sampling from upper and lower pole is most accurate method for diagnosis of significant RAS including accessory RAS. Nepalese Journal of Radiology; Vol. 2; Issue 2; July-Dec. 2012; 59-64 DOI: http://dx.doi.org/10.3126/njr.v2i2.7687

scholarly journals SP111ECHO COLOR DOPPLER STUDY DEMONSTRATING AN HIGHER INCIDENCE OF LEFT VS RIGHT RENAL ARTERY STENOSIS IN OLD PEOPLE

2018 ◽  
Vol 33 (suppl_1) ◽  
pp. i381-i381
Author(s):  
Claudio Orsi ◽  
Brunilda Sejdiu ◽  
Valentina Demelas ◽  
Vittorio Dalmastri ◽  
Francesco Grammatico ◽  
...  
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Color Doppler ◽  
Artery Stenosis ◽  
Old People ◽  
Doppler Study

scholarly journals Renovascular Hypertension: Clinical Features, Differential Diagnoses and Basic Principles of Treatment

2016 ◽  
Vol 17 (3) ◽  
pp. 251-256
Author(s):  
Dejan Petrovic ◽  
Miodrag Sreckovic ◽  
Tomislav Nikolic ◽  
Marija Zivkovic-Radojevic ◽  
Vladimir Miloradovic
Keyword(s):  
Renal Artery ◽  
Pulmonary Oedema ◽  
Renal Artery Stenosis ◽  
Renovascular Hypertension ◽  
Resistant Hypertension ◽  
Systolic Pressure ◽  
Resistance Index ◽  
Renal Arteries ◽  
Artery Stenosis ◽  
Acute Pulmonary Oedema

Abstract Renovascular hypertension is caused by renal artery stenosis. Its prevalence in populations of hypertensive patients is 1-8%, and in populations of patients with resistant hypertension, it is up to 20%. The two main causes of stenosis are atherosclerosis and fibromuscular dysplasia of the renal artery. The main clinical consequences of renal artery stenosis include renovascular hypertension, ischemic nephropathy and “flash” acute pulmonary oedema. Unilateral stenosis of the renal artery causes angiotensin II-dependent hypertension, and bilateral stenosis of the renal arteries produces volume-dependent hypertension. Renovascular aetiology of hypertension should be questioned in patients with resistant hypertension, hypertension with a murmur identified upon auscultation of the renal arteries, and a noticeable side-to-side difference in kidney size. Non-invasive diagnostic tests include the determination of concentrations of peripheral vein plasma renin activity, the captopril test, captopril scintigraphy, colour Doppler ultrasonography, computed tomography angiography, and nuclear resonance angiography. Renovasography represents the gold standard for the diagnosis of renovascular hypertension. The indications for revascularization of the renal artery include haemodynamically significant renal artery stenosis (with a systolic pressure gradient at the site of stenosis of - ΔP ≥ 20 mmHg, along with the ratio of the pressure in the distal part of the renal artery (Pd) and aortic pressure (Pa) less than 0.9 (Pd/Pa < 0.9)), resistant hypertension, loss of renal function after administration of ACE inhibitors or angiotensin receptor II blockers, and recurrent flash pulmonary oedema associated with bilateral renal artery stenosis. The contraindications for renal artery revascularization include a longitudinal diameter of the affected kidney that is less than 8.0 cm, the resistance index measured from the segmental arteries peak blood flow (RI) > 0.8, chronic kidney disease (GFR <30 ml/min/1.73 m2) and negative captopril scintigraphy (lack of lateralization).

scholarly journals Spontaneously Resolving Hyperreninemic Hypertension Caused by Accessory Renal Artery Stenosis in a 13-Year-Old Girl: A Case Report

2016 ◽  
Vol 19 (1) ◽  
pp. 100-102 ◽  
Author(s):  
Ismail Hakki Akbeyaz ◽  
Amit Tirosh ◽  
Cemre Robinson ◽  
Miranda M. Broadney ◽  
Georgios Z. Papadakis ◽  
...  
Keyword(s):  
Case Report ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Artery Stenosis ◽  
Accessory Renal Artery

Duplex derived intrarenal resistance index correlates with invasive pressure gradient measurements in detecting relevant unilateral renal artery stenosis

VASA ◽  
2016 ◽  
Vol 45 (2) ◽  
pp. 175-180 ◽  
Author(s):  
Elias Noory ◽  
Aljoscha Rastan ◽  
Ulrich Beschorner ◽  
Roland Macharzina ◽  
Thomas Zeller
Keyword(s):  
Pressure Gradient ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Linear Regression Analysis ◽  
Balloon Catheter ◽  
Resistance Index ◽  
Artery Stenosis ◽  
Cross Sectional ◽  
Contralateral Kidney ◽  
Gradient Measurements

Abstract. Background: The purpose of this study was to assess the correlation between the transstenotic pressure gradient as determined by a pressure wire and the decrease in the intrarenal resistance index (RI) > 0.05 measured by duplex ultrasound in significant unilateral renal artery stenosis (RAS). Intravascular ultrasound (IVUS) was correlated to the angiographic degree of RAS. Patients and methods: In 17 patients, transstenotic pressure gradient measurements, IVUS and RI measurements were obtained before and after stenting. After stenting, graded stenosis was created by progressive balloon catheter inflation. Stenosis severity was expressed as the ratio of the distal pressure (Pd) corrected for aortic pressure (Pa). The balloon inflation pressure was adjusted to create a stenosis with Pd/Pa ratio 1.0 to 0.7. In parallel, RI measurements were performed in the affected kidney and compared to the contralateral kidney for the calculation of the side-difference in RI. IVUS was performed to correlate the cross-sectional degree of stenosis with quantitative angiography (QA). Results: In 60 out 68 measurements, the RI difference (decline > 0.05) correlated with a Pd/Pa ratio < 0.9; this correlation was significant by linear regression analysis (p < 0.001). The preinterventional mean degree of stenosis was 63.4 % + 16.1 (24.6 - 84.6 %) as assessed by QA and 76.7 % + 13.2 % (47 - 92 %) as assessed by IVUS, showing a significant correlation (p < 0.035). Conclusions: In unilateral RAS, a drop in RI > 0.05 as compared to the unaffected kidney correlates to an invasively measured Pd/Pa ratio < 0.9, which is regarded as a significant pressure gradient associated with increased renin production, which promotes renovascular hypertension. QA underestimates RAS severity as compared to IVUS.

scholarly journals Accessory Renal Artery Stenosis and Secondary Hypertension

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Ariel A. Chung ◽  
Patricia R. Millner
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Renal Vein ◽  
Case Reports ◽  
Single Agent ◽  
Young Patients ◽  
Secondary Hypertension ◽  
Artery Stenosis ◽  
Accessory Renal Artery ◽  
Anatomical Variant

Background. Secondary hypertension is an uncommon cause of hypertension with extensive workup not recommended in most patients; however, further evaluation is generally recommended in young patients presenting with hypertension. Case Presentation. A 31-year-old female presented with history of elevated blood pressures. Secondary hypertension workup revealed no laboratory abnormalities; however, renal artery ultrasound demonstrated a left superior accessory artery and suspected bilateral renal vein congestion that was further evaluated with renal CT with contrast. Renal CT showed ostial stenosis of the left accessory renal artery. In addition, compression of the left renal vein between aorta and superior mesenteric artery was also noted, consistent with nutcracker syndrome. Hypertension was suspected to be secondary to stenosis of the accessory renal artery. Upon consultation with interventional radiology, pharmacologic treatment was recommended, and blood pressure control was ultimately achieved with a single agent. Discussion. Renovascular etiologies are responsible for 1% of cases of mild hypertension and up to 45% of severe hypertension. Accessory renal arteries are a normal anatomical variant in approximately 30% of the population. Secondary hypertension due to stenosis of an accessory renal artery is rare with very few cases described in case reports. Conclusion. Though hypertension secondary to accessory renal artery stenosis is rare and not well published in medical literature, few case reports, including this one, demonstrate that accessory renal artery stenosis can be an underlying etiology of hypertension.

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