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Kang YY, Chen Y, Wu QH, Dong H, Zou YB, Gao PJ, Xu JZ, Jiang XJ, Wang JG. Prevalence and clinical characteristics of renovascular hypertension associated with fibromuscular dysplasia in China. J Hypertens 2023; 41:638-647. [PMID: 36723459 PMCID: PMC9994795 DOI: 10.1097/hjh.0000000000003382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 12/12/2022] [Accepted: 01/08/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the clinical characteristics of renal artery fibromuscular dysplasia (FMD) in patients in China and identify the cure rate of hypertension after angioplasty. METHODS Consecutive hypertensive patients with renal artery stenosis caused by FMD who underwent catheter-based angiography, and were followed at two Chinese referral centres, were retrospectively analysed. All patients underwent a detailed investigation, including demographic characteristics, clinical characteristics, biochemical sampling, Doppler ultrasonography of carotid arteries, magnetic resonance angiography (MRA) of the intracranial artery, and CTA or MRA of the abdominal artery and catheter-based renal angiography. Patients were routinely followed up at 1 month, 6 months and every year after the procedure. RESULTS Among 245 study participants, with a mean diagnosed age of 26.9 ± 9.9 years, 137 (55.9%) were women, and 38 (15.5%) were children. All patients were diagnosed with hypertension at a mean age of 23.4 ± 8.4 years. There were 73.5% focal and 15.2% multivessel cases. Aneurysms, arterial dissections and total occlusions were found in 21.6, 4.1 and 12.2% of patients, respectively. Patients with multifocal FMD were older (26.0 vs. 23.7 years, P = 0.021) and more often female (70.8 vs. 50.6%, P = 0.004). Among children with renal FMD, 55.2% were men, and 86.8% were focal. After a median follow-up of 7.0 years, multifocal FMD had a higher cure rate of hypertension than focal FMD after revascularization (71.7 vs. 55.8%, P = 0.032). CONCLUSION In a cohort of mostly young Chinese patients, the prevalence of hypertension associated with renal FMD is similar in both sexes. Focal FMDs were more frequent than the multifocal ones and, after angioplasty, were associated with a worse blood pressure outcome.
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Affiliation(s)
- Yuan-Yuan Kang
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Yang Chen
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi-Hong Wu
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Hui Dong
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu-Bao Zou
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping-Jin Gao
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Jian-Zhong Xu
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Xiong-Jing Jiang
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
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Kang Y, Wu Q, Xu J, Hong M, Ma Y, Tang X, Zhu L, Gao P, Wang J. Intravascular ultrasound provides additional insights in the hypertensive patients with focal renal artery fibromuscular dysplasia. Hypertens Res 2023:10.1038/s41440-023-01216-y. [PMID: 36765108 DOI: 10.1038/s41440-023-01216-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/14/2023] [Accepted: 01/14/2023] [Indexed: 02/12/2023]
Abstract
To date, few study has defined the exact role or utility of intravascular ultrasound (IVUS) in the diagnosis and treatment of renal artery fibromuscular dysplasia (FMD). We investigated whether using an IVUS would provide additional insights in the hypertensive patients with focal renal artery FMD. A prospective, observational study, including all patients with focal renal artery FMD admitted to the Ruijin hospital during 6 consecutive years (2015-2021). Based on IVUS imaging, focal FMD patients were classified as two subtypes: intima-media thickening (IMT) and negative remodeling (NR) of the whole vessel. A total of 36 consecutive patients (24 ± 7, 13-39 years) with focal renal artery FMD were enrolled. Angiographic unifocal type was present in 22 (61.1%) patients and tubular type was present in 14 (38.9%) patients. Among 22 patients with unifocal, IVUS showed that 18 (81.8%) had IMT and 4 (18.2%) had NR. 14 patients with tubular, IVUS showed 3 (21.4%) had IMT and 11 (78.6%) had NR. No difference in age of onset, gender, BMI, initial BP levels were found between IMT and NR subtypes. However, hypertension cure rates of short-term (48 h after angioplasty) (76.2% vs. 26.7%, p = 0.004) and long-term (1-6years) (90.5% vs. 20.0%, p < 0.001) were higher in patients with IMT than in those with NR subtype. In present study, we described a new classification of focal renal artery FMD into IMT or NR subtype based on IVUS. Renal FMD Patients with IMT subtype were more likely to achieve cure of hypertension. We investigated whether using an IVUS would provide additional insights in the hypertensive patients with focal renal artery FMD. A new classification of focal renal artery FMD into IMT or NR subtype based on IVUS was described. Renal FMD Patients with IMT subtype were more likely to achieve cure of hypertension.
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Affiliation(s)
- Yuanyuan Kang
- Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qihong Wu
- Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianzhong Xu
- Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Mona Hong
- Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Ma
- Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Tang
- Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Limin Zhu
- Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pingjin Gao
- Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiguang Wang
- Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Oribe S, Toyohara T, Mishima E, Suzuki T, Kikuchi K, Watanabe S, Morita Y, Ota H, Seiji K, Miyazaki M, Takase K, Abe T. Fibromuscular dysplasia with recurrence after "long-term" following percutaneous transcatheter renal angioplasty: two case reports with a review of 26 patients. BMC Nephrol 2021; 22:187. [PMID: 34016044 PMCID: PMC8135181 DOI: 10.1186/s12882-021-02342-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Fibromuscular dysplasia (FMD) often causes renal artery stenosis with renovascular hypertension. Recent clinical outcomes encourage percutaneous transluminal renal angioplasty (PTRA) to treat FMD; however, the necessary follow-up period remains unclear. Moreover, previous studies have not revealed the difference in the period until recurrence between two major types of FMD—multifocal and focal. Case presentation We describe two patients with multifocal FMD who developed hypertension during their teenage years and had recurrence of FMD > 10 years after PTRA. We further examined the types of FMD and age of onset in 26 patients who underwent PTRA. The period until recurrence of multifocal FMD was longer than that of focal FMD. Moreover, patients with early-onset multifocal FMD are likely to have a delayed recurrence after PTRA compared to other types. Conclusions Our report suggests that patients with multifocal FMD, especially those with onset at an early age, may need long-term follow-up for at least ≥ 10 years.
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Affiliation(s)
- Shuntaro Oribe
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takafumi Toyohara
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Medical Science, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Eikan Mishima
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takehiro Suzuki
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Medical Science, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Koichi Kikuchi
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shun Watanabe
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Morita
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazumasa Seiji
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mariko Miyazaki
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaaki Abe
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. .,Division of Medical Science, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan. .,Department of Clinical Biology and Hormonal Regulation, Tohoku University Graduate School of Medicine, 980-8574, Sendai, Japan.
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Kidney enlargement effect of angioplasty for nonatherosclerotic renovascular disease: reversibility of ischemic kidney. Hypertens Res 2020; 43:1214-1221. [PMID: 32444857 DOI: 10.1038/s41440-020-0473-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 11/08/2022]
Abstract
Renal artery stenosis causes kidney ischemia, reducing the size of the affected kidney, which eventually results in atrophy. Although renal atrophy is considered irreversible, resolution of the ischemia occasionally restores kidney size when the cause is renal artery stenosis. Angioplasty is effective in patients with nonatherosclerotic renovascular diseases (non-ARVDs). Nevertheless, renal enlargement after angioplasty has not been fully examined. We conducted a retrospective study to examine this phenomenon in non-ARVD patients. Ten patients with a <100-mm pole-to-pole length of the poststenotic kidney were treated with angioplasty. Data were collected up to 12 months after angioplasty. The mean age was 28 years; the estimated glomerular filtration rate was 92 ± 7 mL/min/1.73 m2 (mean ± SEM); blood pressure was 150/99 mmHg; 80% were women; and fibromuscular dysplasia was present in 90% of the patients. All patients had hypertension. The lengths of the poststenotic and contralateral kidney before angioplasty were 91 ± 1 and 111 ± 3 mm, respectively. After angioplasty, the length of the poststenotic kidney gradually increased during the 3 months after treatment (+5.4 mm) and that of the contralateral kidney decreased over the same time course (-3.7 mm). Enlargement was also found in the moderate atrophy subgroup (length < 92 mm), and it was greater in the <30 years old group. In a noteworthy case, renal size in the poststenotic kidney recovered from 87 to 102 mm after angioplasty. Our findings demonstrated that reduced renal size can be reversed after optimal angioplasty in non-ARVD patients, especially young patients, suggesting reversibility of the ischemic kidney.
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Kazantsev AN, Burkov NN, Lider RY, Shabayev AR, Bayandin MS, Kazantseva EG. [In-hospital results of renal artery stenting in patients with multifocal atherosclerosis]. Khirurgiia (Mosk) 2020:43-47. [PMID: 32271736 DOI: 10.17116/hirurgia202003143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A retrospective analysis of in-hospital results of renal artery stenting in patients with multifocal atherosclerosis. MATERIAL AND METHODS The study included 19 patients who underwent stenting for renal artery stenosis for the period 2011-2015 in the Kemerovo Cardiology Dispensary. Renal function was assessed considering glomerular filtration rate (GFR). Blood pressure and GFR were evaluated before the stenting procedure and at discharge. RESULTS Stenting resulted optimal outcomes in all 19 patients. Severity of residual stenosis was 11±3%. In-hospital mortality was absent. Blood pressure in early postoperative period was similar to baseline values. One patient had a normalization of blood pressure up to 115-140/85-90 mm Hg without administration of antihypertensive drugs. Decrease of systolic blood pressure up to 155.3±32.6 mm Hg was noted in other patients at discharge. Blood creatinine levels decreased up to 0.167±0.56 mmol/L. In addition, mean GFR increased from 34.17 ml/min/1.69 m2 up to 37.16 ml/min/1.69 m2. CONCLUSION Endovascular treatment of renal artery stenosis and secondary hypertension is effective and relatively safe approach.
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Affiliation(s)
- A N Kazantsev
- Academician Barbarash Kemerovo Regional Clinical Cardiology Dispensary, Kemerovo, Russia
| | - N N Burkov
- Academician Barbarash Kemerovo Regional Clinical Cardiology Dispensary, Kemerovo, Russia
| | - R Yu Lider
- Kemerovo State Medical University of the Ministry of Health of Russia, Kemerovo, Russia
| | - A R Shabayev
- Academician Barbarash Kemerovo Regional Clinical Cardiology Dispensary, Kemerovo, Russia
| | - M S Bayandin
- Kemerovo State Medical University of the Ministry of Health of Russia, Kemerovo, Russia
| | - E G Kazantseva
- Kemerovo State Medical University of the Ministry of Health of Russia, Kemerovo, Russia
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Lam D, Jansen S, Tibballs J, McLean-Tooke A. Fibromuscular dysplasia presenting with a deep vein thrombosis. BMJ Case Rep 2020; 13:13/2/e233315. [PMID: 32094235 DOI: 10.1136/bcr-2019-233315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 41-year-old male patient presented with isolated right lower limb swelling. An ultrasound scan showed right external iliac and femoral vein deep vein thrombosis due to extrinsic compression by an aneurysm of the right common iliac artery. Investigations including imaging and a tissue biopsy of right and left femoral arteries confirmed a rare clinical presentation of fibromuscular dysplasia involving iliac, coeliac, renal and pulmonary vessels. The common iliac artery aneurysm was successfully treated with endovascular repair. Six months later, he developed coronary artery involvement with spontaneous dissection of left anterior descending artery diagnosed on coronary angiogram which was managed conservatively. At 6-year follow-up, he remains clinically asymptomatic and continues with regular surveillance imaging. Iliac arterial fibromuscular dysplasia is uncommon and clinical presentation with a complication such as a deep vein thrombosis is atypical.
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Affiliation(s)
- Danielle Lam
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Shirley Jansen
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Jonathan Tibballs
- Department of Interventional Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia .,Department of Immunology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
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