Efficacy of renal revascularization in a patient with fibromuscular renal artery stenosis and heart failure

The use of intrarenal Doppler ultrasonography as predictor for positive outcome after renal artery revascularization

Whether patients with renal artery stenosis should undergo therapeutic revascularization is controversial. In this retrospective study, we evaluated prognostic intrarenal Doppler ultrasound parameters that might have a predictive value for a beneficial response after renal revascularization. From January 2003 until December 2012, all renovascular interventions for renal artery stenosis were analyzed. The resistive index and the maximal systolic acceleration were determined by Doppler ultrasonography prior to intervention. Thirty-two patients who underwent a renal revascularization procedure were included: 13 combined positive responders and 19 combined non-responders. The combined positive responders had a significant lower resistive index than the combined non-responders (0.5 vs. 0.6, P = 0.001) and a significant lower maximal systolic acceleration (1.0 vs. 3.8, P = 0.001) before revascularization. A prediction model (RI ≤ 0.5 and ACC_max ≤ 1.3 m/s²) was formulated to identify a subgroup that benefits from renal revascularization. This model has an expected sensitivity of 69% and specificity of 89% for improvement in renal function and/or blood pressure after revascularization. The non-invasive intrarenal Doppler ultrasound parameters resistive index and maximal systolic acceleration can be used as tools to predict improvement in renal function and/or blood pressure after revascularization of renal artery stenosis. The clinical value of this prediction model should be evaluated in a prospective trial.

Fibromuscular dysplasia affecting a two-branched renal artery in a patient with a solitary kidney: case presentation

Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory arterial disease, commonly involving the renal arteries. Here we report a case of a 16-year-old Chinese male who was found to have severe hypertension with proteinuria for 2 years. Computed tomography showed absence of the left kidney and enlargement of the right kidney. Subsequent angiography confirmed the above findings and revealed narrowing of both the upper and lower branches of the right renal artery caused by FMD. These combined lesions are very rare, and individuals affected are at increased risk of renal dysfunction if left untreated. Treatment with percutaneous balloon angioplasty is the first choice in such a patient and usually results in optimal outcomes.