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İriz E, Tak S, Yiğiter EN, Leventoğlu E, Demirtaş H, Akkuzu E, Uysal Yazıcı M, Fidan K, Dalgıç A. A rare cause and an even rarer treatment of hypertension in a 5-year-old boy: Mid-aortic syndrome. Nephrology (Carlton) 2024; 29:230-234. [PMID: 38109884 DOI: 10.1111/nep.14262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023]
Abstract
Renal artery stenosis is one of the common vascular diseases that cause hypertension in children. However, renal artery aneurysms and abdominal aortic aneurysms, which may be components of mid-aortic syndrome, are rarely associated with renal artery stenosis. Despite its rarity, early diagnosis and treatment are critical to prevent fatal complications. Currently, non-surgical invasive techniques are considered the first choice for treatment, but in some cases, surgery is inevitable. Here, we present a 5-year-old boy with a mid-aortic syndrome. The patient presented with a history of severe headache and epistaxis 5-6 times a day and was diagnosed with hypertension. A 9 × 9 mm saccular aneurysm on the anterior surface of the abdominal aorta at the level of the left renal artery ostium, and a 12 mm aneurysm in the left renal artery after a stenotic segment at the hilum level was detected in the doppler USG and contrast-enhanced imaging techniques. The patient was operated on electively. We used a PTFE patch to repair the abdominal aorta and, saphenous vein which was taken from his father to repair the renal artery. The patient recovered well and was discharged on the 18th day.
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Affiliation(s)
- Erkan İriz
- Faculty of Medicine, Department of Cardiovascular Surgery, Gazi University, Ankara, Turkey
| | - Sercan Tak
- Faculty of Medicine, Department of Cardiovascular Surgery, Gazi University, Ankara, Turkey
| | - Eda Nur Yiğiter
- Faculty of Medicine, Department of Cardiovascular Surgery, Gazi University, Ankara, Turkey
| | - Emre Leventoğlu
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Hüseyin Demirtaş
- Faculty of Medicine, Department of Cardiovascular Surgery, Gazi University, Ankara, Turkey
| | - Emine Akkuzu
- Faculty of Medicine, Department of Pediatric Intensive Care, Gazi University, Ankara, Turkey
| | - Mutlu Uysal Yazıcı
- Faculty of Medicine, Department of Pediatric Intensive Care, Gazi University, Ankara, Turkey
| | - Kibriya Fidan
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Aydın Dalgıç
- Faculty of Medicine, Department of General Surgery, Gazi University, Ankara, Turkey
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Toshniwal S, Sahai I, Ghosh B, Chaturvedi A, Agrawal G, Acharya S, Kumar S, Khadse S, Khurana K. Case Report: Multiple atherosclerotic plaques at its extreme in synchrony. F1000Res 2024; 12:738. [PMID: 38434660 PMCID: PMC10905029 DOI: 10.12688/f1000research.135416.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/05/2024] Open
Abstract
Peripheral artery (PAD) disease in association with renal artery stenosis is an important association which predicts the severity of the disease. An increase in the number of vessels affected by peripheral artery disease increases the chances of renal artery stenosis. In our case, the patient had primarily presented with anginal chest pain with complaints of claudication which on further investigation was diagnosed to be a triple vessel coronary artery disease along with bilateral subclavian and bilateral renal stenosis. On detailed history taking, risk factors like hypertension and chronic smoking was found to be present in our case which predisposed to peripheral artery disease secondary to atherosclerosis which was diagnosed on further investigations. Although the association of renal artery stenosis is not very rare in cases of severe peripheral vascular diseases, the presence of a triple vessel coronary artery disease in synchrony is what makes it unique. Take away lesson from this case report is importance of early diagnosis of dyslipidemia causing atherosclerosis and its complications. Multiple atherosclerotic lesions in synchrony i.e, bilateral renal artery stenosis with bilateral subclavian artery stenosis with coronary artery triple vessel atherosclerotic disease like in our case and its severity should create awareness among health care individuals and early treatment measures including lifestyle modifications should be considered to avoid such drastic events.
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Affiliation(s)
- Saket Toshniwal
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Isha Sahai
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Benumadhab Ghosh
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Anuj Chaturvedi
- Cardiology, Jawaharlal Nehru medical college, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
| | - Gajendra Agrawal
- Cardiology, Jawaharlal Nehru medical college, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
| | - Sourya Acharya
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Sunil Kumar
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Satish Khadse
- Cardiology, Jawaharlal Nehru medical college, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
| | - Kashish Khurana
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
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3
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Toshniwal S, Sahai I, Ghosh B, Chaturvedi A, Agrawal G, Acharya S, Kumar S, Khadse S, Khurana K. Case Report: Multiple atherosclerotic plaques at its extreme in synchrony. F1000Res 2024; 12:738. [PMID: 38434660 PMCID: PMC10905029 DOI: 10.12688/f1000research.135416.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 04/13/2024] Open
Abstract
Peripheral artery (PAD) disease in association with renal artery stenosis is an important association which predicts the severity of the disease. An increase in the number of vessels affected by peripheral artery disease increases the chances of renal artery stenosis. In our case, the patient had primarily presented with anginal chest pain with complaints of claudication which on further investigation was diagnosed to be a triple vessel coronary artery disease along with bilateral subclavian and bilateral renal stenosis. On detailed history taking, risk factors like hypertension and chronic smoking was found to be present in our case which predisposed to peripheral artery disease secondary to atherosclerosis which was diagnosed on further investigations. Although the association of renal artery stenosis is not very rare in cases of severe peripheral vascular diseases, the presence of a triple vessel coronary artery disease in synchrony is what makes it unique. Take away lesson from this case report is importance of early diagnosis of dyslipidemia causing atherosclerosis and its complications. Multiple atherosclerotic lesions in synchrony i.e, bilateral renal artery stenosis with bilateral subclavian artery stenosis with coronary artery triple vessel atherosclerotic disease like in our case and its severity should create awareness among health care individuals and early treatment measures including lifestyle modifications should be considered to avoid such drastic events.
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Affiliation(s)
- Saket Toshniwal
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Isha Sahai
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Benumadhab Ghosh
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Anuj Chaturvedi
- Cardiology, Jawaharlal Nehru medical college, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
| | - Gajendra Agrawal
- Cardiology, Jawaharlal Nehru medical college, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
| | - Sourya Acharya
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Sunil Kumar
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
| | - Satish Khadse
- Cardiology, Jawaharlal Nehru medical college, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
| | - Kashish Khurana
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of higher education and research, Wardha, Maharashtra, 442001, India
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4
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Mesa-Maya MA, Duque-Gonzalez L, Franco-Sierra S. Takayasu's arteritis presenting as acute STEMI. J Invasive Cardiol 2023; 35. [PMID: 38108877 DOI: 10.25270/jic/23.00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
An 18-year-old man with past medical history of secondary arterial hypertension diagnosed at age 15 presented with an abdominal magnetic resonance imaging (MRI) that exhibited left renal artery stenosis.
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Affiliation(s)
| | - Laura Duque-Gonzalez
- AUNA Clínica Las Américas, Medellín, Antioquia, Colombia; Hospital San Vicente Fundación, Rionegro, Antioquia, Colombia.
| | - Sergio Franco-Sierra
- AUNA Clínica Las Américas, Medellín, Antioquia, Colombia; Hospital San Vicente Fundación, Rionegro, Antioquia, Colombia
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Sarafidis PA, Theodorakopoulou M, Ortiz A, Fernandez-Fernández B, Nistor I, Schmieder R, Arici M, Saratzis A, Van der Niepen P, Halimi JM, Kreutz R, Januszewicz A, Persu A, Cozzolino M. Atherosclerotic renovascular disease: a clinical practice document by the European Renal Best Practice (ERBP) board of the European Renal Association (ERA) and the Working Group Hypertension and the Kidney of the European Society of Hypertension (ESH). Nephrol Dial Transplant 2023; 38:2835-2850. [PMID: 37202218 PMCID: PMC10689166 DOI: 10.1093/ndt/gfad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Indexed: 05/20/2023] Open
Abstract
Atherosclerotic renovascular disease (ARVD) is the most common type of renal artery stenosis. It represents a common health problem with clinical presentations relevant to many medical specialties and carries a high risk for future cardiovascular and renal events, as well as overall mortality. The available evidence regarding the management of ARVD is conflicting. Randomized controlled trials failed to demonstrate superiority of percutaneous transluminal renal artery angioplasty (PTRA) with or without stenting in addition to standard medical therapy compared with medical therapy alone in lowering blood pressure levels or preventing adverse renal and cardiovascular outcomes in patients with ARVD, but they carried several limitations and met important criticism. Observational studies showed that PTRA is associated with future cardiorenal benefits in patients presenting with high-risk ARVD phenotypes (i.e. flash pulmonary oedema, resistant hypertension or rapid loss of kidney function). This clinical practice document, prepared by experts from the European Renal Best Practice (ERBP) board of the European Renal Association (ERA) and from the Working Group on Hypertension and the Kidney of the European Society of Hypertension (ESH), summarizes current knowledge in epidemiology, pathophysiology and diagnostic assessment of ARVD and presents, following a systematic literature review, key evidence relevant to treatment, with an aim to support clinicians in decision making and everyday management of patients with this condition.
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Affiliation(s)
- Pantelis A Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marieta Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | | | - Ionut Nistor
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
- Department of Nephrology, Dr C I Parhon University Hospital, Iasi, Romania
| | - Roland Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Mustafa Arici
- Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences & Leicester Vascular Institute, University Hospital Leicester, Leicester, UK
| | - Patricia Van der Niepen
- Department of Nephrology & Hypertension, Universitair ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jean-Michel Halimi
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, CHRU Tours, Tours, France and INSERM SPHERE U1246, Université Tours, Université de Nantes, Tours, France
| | - Reinhold Kreutz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Mario Cozzolino
- Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
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6
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Bhalla V, Textor SC, Beckman JA, Casanegra AI, Cooper CJ, Kim ESH, Luther JM, Misra S, Oderich GS. Revascularization for Renovascular Disease: A Scientific Statement From the American Heart Association. Hypertension 2022; 79:e128-e143. [PMID: 35708012 DOI: 10.1161/hyp.0000000000000217] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renovascular disease is a major causal factor for secondary hypertension and renal ischemic disease. However, several prospective, randomized trials for atherosclerotic disease failed to demonstrate that renal revascularization is more effective than medical therapy for most patients. These results have greatly reduced the generalized diagnostic workup and use of renal revascularization. Most guidelines and review articles emphasize the limited average improvement and fail to identify those clinical populations that do benefit from revascularization. On the basis of the clinical experience of hypertension centers, specialists have continued selective revascularization, albeit without a summary statement by a major, multidisciplinary, national organization that identifies specific populations that may benefit. In this scientific statement for health care professionals and the public-at-large, we review the strengths and weaknesses of randomized trials in revascularization and highlight (1) when referral for consideration of diagnostic workup and therapy may be warranted, (2) the evidence/rationale for these selective scenarios, (3) interventional and surgical techniques for effective revascularization, and (4) areas of research with unmet need.
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7
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Wu LF, Shao L, Gao C, Wang X, Qi YH, Wang ZJ. [Misdiagnosis of Acute Renal Artery Thrombosis as Acute Abdominal Disease:Report of One Case]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2022; 44:177-180. [PMID: 35300782 DOI: 10.3881/j.issn.1000-503x.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Renal artery thrombosis can cause acute occlusion of unilateral or bilateral renal arteries,and kidney failure would be induced if it is not diagnosed and treated in time.Therefore,rapid and correct treatment is especially important for renal artery thrombosis.Due to the lack of specificity of clinical manifestations,this disease in commonly misdiagnosed or missed and thus has a low early diagnosis rate.Here we report a case of acute renal artery thrombosis to improve the diagnosis and treatment.
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Affiliation(s)
- Li-Fei Wu
- Department of Cardiovascular Surgery,First Hospital of Fangshan District,Beijing 102400,China
| | - Lei Shao
- Department of Cardiovascular Surgery,First Hospital of Fangshan District,Beijing 102400,China
| | - Chao Gao
- Department of Cardiovascular Surgery,First Hospital of Fangshan District,Beijing 102400,China
| | - Xiang Wang
- Department of Cardiovascular Surgery,First Hospital of Fangshan District,Beijing 102400,China
| | - Yu-Hang Qi
- Department of Cardiovascular Surgery,First Hospital of Fangshan District,Beijing 102400,China
| | - Zi-Jun Wang
- Department of Cardiovascular Surgery,First Hospital of Fangshan District,Beijing 102400,China
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Sharma S, Henkin S, Young MN. Renovascular Disease and Mesenteric Vascular Disease. Cardiol Clin 2021; 39:527-537. [PMID: 34686265 DOI: 10.1016/j.ccl.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Renal artery stenosis is caused by atherosclerosis and fibromuscular dysplasia and is associated with ischemic nephropathy, renovascular hypertension, and accelerated cardiovascular disease. Routine screening for renal artery stenosis is not recommended but is reasonable in patients who have rapid onset of hypertension, resistant hypertension, progressive renal insufficiency, recurrent pulmonary edema, or repeat admissions for heart failure. Acute mesenteric ischemia is caused by arterial embolism or thrombosis, mesenteric venous thrombosis, or nonocclusive mesenteric ischemia, whereas chronic mesenteric ischemia is most often caused by arterial obstruction. This article reviews the epidemiology, pathophysiology, diagnosis, and management of these two conditions.
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Affiliation(s)
- Swapna Sharma
- The Elliot Hospital, 1 Elliot Way, Manchester, NH 03103, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Michael N Young
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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Kim Y, Kim MH, Hwang JK, Park SC, Kim JI, Jun KW. Endovascular treatment for transplant renal artery stenosis: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e26935. [PMID: 34397942 PMCID: PMC8360457 DOI: 10.1097/md.0000000000026935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/27/2021] [Indexed: 01/04/2023] Open
Abstract
Transplant renal artery stenosis (TRAS) is the most common (1%-23%) vascular complication following kidney transplantation. The aim of this study was to review our experience with an endovascular approach to treat TRAS.We retrospectively reviewed kidney transplant recipients who underwent percutaneous transluminal angioplasty (PTA) due to TRAS in our institute from January 2009 to December 2015. We analyzed the patient's baseline characteristics, postoperative renal function, blood pressure evolution, and the number of pre- and post-procedure antihypertensive drugs.A total of 21 patients (15 men, 6 women) were treated with the endovascular technique. The predominant presentation was graft dysfunction (76.2%). Stenosis or hemodynamic kinking was located at the anastomosis in 7 (33.3%) patients, proximal to the anastomosis in 13 (61.9%) patients, and distal the anastomosis in 1 (4.8%) patient. PTA without stent placement was performed in 7 patients (33.3%), and PTA with stent placement was performed in 14 patients (67.7%). Serum creatinine levels demonstrated no difference between the pre-procedure level and that on discharge day (1.61 mg/dl [0.47-3.29 mg/dl] vs 1.46 mg/dl [0.47-3.08 mg/dl]; P = .33). The glomerular filtration rate also showed no difference between the pre-procedure value and that on discharge day (53.6 ml/min [22.4-145.7 ml/min] vs 57.0 ml/min [17.56 -145 ml/min]; P = .084). Systolic blood pressure and diastolic blood pressure (DBP) varied from 137 mm Hg (120-160 mm Hg) and 84 mm Hg (70-100 mm Hg) pre-procedure to 129 mm Hg (90-150 mm Hg) and 79 mm Hg (60-90 mm Hg) at discharge, respectively (P = .124 and P = .07). The number of antihypertensive medications significantly decreased from 1.5 (0-6) pre-procedure to 0.5 (0-2) at discharge (P = .023). In our study, there were no technical failures, procedure-related complications or deaths. During the follow-up period, the free-from-reintervention rate was 100%, and graft failures occurred in 2 patients (9.5%) due to rejection.Endovascular procedures for TRAS show a high technical success rate with a low complication rate and a low reintervention rate. PTA showed a trend toward a positive impact on lowering serum creatinine, systolic blood pressure, and diastolic blood pressure and improving estimated glomerular filtration rate, and the number of antihypertensive medications could be significantly reduced after this procedure.
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Affiliation(s)
- Youngmin Kim
- Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Hyeong Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Kye Hwang
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Cheol Park
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Il Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kang Woong Jun
- Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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van de Velde L, Collard D, Spiering W, van Brussel PM, Versmissen J, Wierema T, de Haan MW, Zijlstra IAJ, Kroon AA, Vogt L, de Leeuw PW, van Twist D, van den Born BJH. New diagnostic and treatment strategies in renal artery stenosis: a promising pursuit or disappointment foretold? Neth J Med 2020; 78:232-238. [PMID: 33093246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Clinical management of renal artery stenosis has seen a major shift, after randomised clinical trials have shown no group benefit of endovascular intervention relative to optimal medical control. However, the inclusion criteria of these trials have been criticised for focusing on a subset of patients with atherosclerotic renal artery stenosis where intervention was unlikely to be beneficial. Moreover, new imaging and computational techniques have become available, which have the potential to improve identification of patients that will respond to interventional treatment. This review addresses the challenges associated with clinical decision making in patients with renal artery stenosis. Opportunities for novel diagnostic techniques to improve patient selection are discussed, along with ongoing Dutch studies and network initiatives that investigate these strategies.
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Affiliation(s)
- L van de Velde
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Mishima E, Ota H, Suzuki T, Toyohara T, Seiji K, Ito S, Saiki Y, Takase K, Abe T. Apparent Diffusion Coefficient in the Resolution of Renal Ischemia after Angioplasty on Diffusion-weighted Imaging: Renal Artery Stenosis Caused by Progressive Thrombosis in Residual Chronic Aortic Dissection. Intern Med 2020; 59:1173-1177. [PMID: 31956203 PMCID: PMC7270755 DOI: 10.2169/internalmedicine.3855-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case in which diffusion-weighted magnetic resonance imaging (DWI) demonstrated renal artery stenosis-related renal ischemia and the therapeutic efficacy of revascularization. The patient was a 73-year-old man, who underwent descending thoracic aortic replacement due to DeBakey IIIb chronic aortic dissection, and who showed progressive renal dysfunction due to right renal artery stenosis caused by false lumen thrombosis. DWI demonstrated a decreased apparent diffusion coefficient (ADC) in the right kidney, indicating renal ischemia. Angioplasty with stenting restored renal perfusion and improved the renal function, resulting in the normalization of the decreased ADC in the treated kidney. Thus, DWI can be used to monitor renal ischemia in cases involving advanced renal artery stenosis.
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Affiliation(s)
- Eikan Mishima
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Japan
| | - Takehiro Suzuki
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Takafumi Toyohara
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Kazumasa Seiji
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Japan
| | | | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Japan
| | - Takaaki Abe
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan
- Division of Medical Science, Tohoku University Graduate School of Biomedical Engineering, Japan
- Department of Clinical Biology and Hormonal Regulation, Tohoku University Graduate School of Medicine, Japan
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Abstract
Atherosclerotic renal artery stenosis is the most common cause of secondary hypertension and may cause progressive renal disease and cardiac destabilization syndromes. Guideline-directed medical therapy is advised in all patients. Patients with refractory symptoms and hemodynamically significant stenoses are more likely to benefit from renal artery stent placement. Chronic mesenteric ischemia (CMI) is an infrequent and difficult to diagnose illness. Due to robust collateralization, clinical symptoms from mesenteric artery stenosis or occlusion is uncommon. Atherosclerosis is the most common etiology of CMI. Current evidence suggests that, compared with open surgical repair, endovascular therapy is the most cost-effective choice for CMI.
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Affiliation(s)
- Tamunoinemi Bob-Manuel
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Center, Ochsner Medical Center, The Ochsner Clinical School, University of Queensland, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Christopher J White
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Center, Ochsner Medical Center, The Ochsner Clinical School, University of Queensland, 1514 Jefferson Highway, New Orleans, LA 70121, USA; Department of Cardiology, Ochsner Medical Center, 3rd Floor, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
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13
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de Souza Alves Ferreira R, Attab Dos Santos JL, Greguolo C, Fabris JF, D'anzicourt Pinto M, Nascimento Paiva A, Resende VP, de Souza CF, Mandaloufas LC, Alves de Urzêda M, Sanchez Antonio R. Acute Renal Infarction Treated With Local Intra-arterial Thrombolysis. J Invasive Cardiol 2020; 32:E15-E16. [PMID: 31893508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 53-year-old man with stable coronary disease and dyslipidemia was admitted with sudden pain of severe intensity in the left flank. Selective catheterization of the left renal artery, followed by alteplase infusion for 6 hours, resolved the patient's symptoms.
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Vijayvergiya R, Budhakoty S, Kumar B, Kasinadhuni G, Kanabar K. Percutaneous Renal Artery Stenting With Optical Coherence Tomography Imaging in a Young Boy With Recanalized-Thrombus Associated Renal Artery Stenosis. J Invasive Cardiol 2020; 32:E9-E10. [PMID: 31893504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The common cause of renal artery stenosis in young is fibromuscular dysplasia or Takayasu arteritis. Recanalized thrombus, on the other hand, is a rare cause for renal artery stenosis in young patients. OCT imaging confirmed the diagnosis and optimized the renal stenting results.
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Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh - 160 012, India.
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Abstract
Renovascular disease (RVD) is a major cause of secondary hypertension. Atherosclerotic renal artery stenosis is the most common type of RVD followed by fibromuscular dysplasia. It has long been recognized as the prototype of angiotensin-dependent hypertension. However, the mechanisms underlying the physiopathology of hypertensive occlusive vascular renal disease are complex and distinction between the different causes of RVD should be made. Recognition of these distinct types of RVD with different degrees of renal occlusive disease is important for management. The greatest challenge is to individualize and implement the best approach for each patient in the setting of widely different comorbidities.
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Affiliation(s)
- Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA.
| | - Stephen C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA
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Ren Z, Zhang X, Hu Z, Li D, Liu Z, Wei D, Jia Y, Yu N, Yu Y, Lei Y, Chen X, Guo C, Ren Z, He T. Application of Adaptive Statistical Iterative Reconstruction-V With Combination of 80 kV for Reducing Radiation Dose and Improving Image Quality in Renal Computed Tomography Angiography for Slim Patients. Acad Radiol 2019; 26:e324-e332. [PMID: 30655053 DOI: 10.1016/j.acra.2018.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/23/2018] [Accepted: 12/24/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To explore the application of adaptive statistical iterative reconstruction-V (ASIR-V) with combination of 80 kV for reducing radiation dose and improving image quality in renal computed tomography angiography (CTA) for slim patients compared with traditional filtered back projection (FBP) reconstruction using 120 kV. METHODS Eighty patients for renal CTA were prospectively enrolled and randomly divided into group A and group B. Group A used 120 kV and 600 mgI/kg contrast agent and FBP reconstruction, while group B used 80 kV and 350 mgI/kg contrast agent and both FBP and ASIR-V reconstruction from 10%ASIR-V to 100%ASIR-V with 10%ASIR-V interval. The CT values and SD values of the right renal artery and left renal artery were measured to calculate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The image quality was subjectively scored by two experienced radiologists blindly using a five-point criterion. The contrast agent, volumetric CT dose index (CTDIvol), and dose length product in both groups were recorded and the effective radiation dose was calculated. RESULTS There were no significant difference in patient characteristics between two groups (p > 0.05). The CTDIvol, dose length product and effective radiation dose in group B were 59.0%, 65.0%, and 65.1% lower than those in group A, respectively (all p < 0.05), and the contrast agent in group B was 42.2% lower than that in group A (p < 0.05). In group B, with the increase of ASIR-V percentage, CT values showed no significant difference, SD values decreased gradually, SNR values and CNR values increased gradually. The CT values showed no statistically significant difference (p > 0.05) between two groups with different reconstructions. The SD values with 40%ASIR-V to 100%ASIR-V reconstruction in group B was significantly lower(p < 0.5), while the SNR values with 50% ASIR-V to 100% ASIR-V reconstruction and CNR values with 70%ASIR-V to 100%ASIR-V were significantly higher than those of group A with FBP reconstruction (p < 0.5). Two radiologists had excellent consistency in subjective scores of image quality for renal CTA (kappa >0.75, p < 0.05). The subjective scores with 60% ASIR-V to 90% ASIR-V in group B were significantly higher than those of FBP in group A (p < 0.5), of which 70%ASIR-V reconstruction obtained the highest subjective score for renal CTA. CONCLUSION ASIR-V with combination of 80 kV can significantly reduce effective radiation dose (about 65.1%) and contrast agent (about 42.2%) and improve image quality in renal CTA for slim patients compared with traditional FBP reconstruction using 120 kV, and the 70% ASIR-V was the best reconstruction algorithm in 80 kV renal CTA. ADVANCES IN KNOWLEDGE Using 80 kV with combination of ASIR-V can significantly reduce radiation dose and contrast agent dose as well as improve image quality in renal CTA for thin patients when compared with FBP using 120 kV.
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Affiliation(s)
- Zhanli Ren
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000; Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China; The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Xirong Zhang
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000
| | - Zhijun Hu
- Department of Medical Imaging, Chang'an Hospital, Xi'an, Shaanxi, China
| | - Dou Li
- Department of Medical Imaging, Chang'an Hospital, Xi'an, Shaanxi, China
| | - Zhentang Liu
- Department of Medical Imaging, Chang'an Hospital, Xi'an, Shaanxi, China
| | - Donghong Wei
- Department of Medical Imaging, Chang'an Hospital, Xi'an, Shaanxi, China
| | - Yongjun Jia
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000
| | - Nan Yu
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000
| | - Yong Yu
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000
| | - Yuxin Lei
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000
| | - Xiaoxia Chen
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000
| | - Changyi Guo
- The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Zhanliang Ren
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000.
| | - Taiping He
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road- 2#, Xianyang, Shaanxi, China 712000.
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Mehta OH, Cameron JD, Mirzaee S. Familial Hypercholesterolemia With Coexisting Renovascular Stenosis and Premature Coronary Artery Disease. Am J Hypertens 2019; 32:730-733. [PMID: 30868157 DOI: 10.1093/ajh/hpz037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/17/2019] [Accepted: 03/06/2019] [Indexed: 11/12/2022] Open
Abstract
Familial hypercholesterolemia (FH) is a common hereditary lipid disorder associated with substantial risk of premature atherosclerotic cardiovascular disease. We report an interesting newly diagnosed index case of FH in a 31-year-old man who presented to the hospital with an ST-elevated myocardial infarction. He had a background of inadequately treated hypertension and hypercholesterolemia. Further investigations raised the possibility of secondary hypertension after the identification of renal artery stenosis, in addition to other areas of mesenteric arterial stenoses. Our patient's case highlights that early-onset hypertension and hypercholesterolemia in a young individual may be an early manifestation of FH requiring high clinical vigilance and awareness.
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Affiliation(s)
- Ojas H Mehta
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
| | - Sam Mirzaee
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
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Jiang K, Ferguson CM, Abumoawad A, Saad A, Textor SC, Lerman LO. A modified two-compartment model for measurement of renal function using dynamic contrast-enhanced computed tomography. PLoS One 2019; 14:e0219605. [PMID: 31291361 PMCID: PMC6619810 DOI: 10.1371/journal.pone.0219605] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/27/2019] [Indexed: 12/14/2022] Open
Abstract
Objectives To validate and adapt a modified two-compartment model, originally developed for magnetic resonance imaging, for measuring human single-kidney glomerular filtration rate (GFR) and perfusion using dynamic contrast-enhanced computed tomography (DCE-CT). Methods This prospective study was approved by the institutional review board, and written informed consent was obtained from all patients. Thirty-eight patients with essential hypertension (EH, n = 13) or atherosclerotic renal artery stenosis (ARAS, n = 25) underwent renal DCE-CT for GFR and perfusion measurement using a modified two-compartment model. Iothalamate clearance was used to measure reference total GFR, which was apportioned into single-kidney GFR by renal blood flow. Renal perfusion was also calculated using a conventional deconvolution algorithm. Validation of GFR and perfusion and inter-observer reproducibility, were conducted by using the Pearson correlation and Bland-Altman analysis. Results Both the two-compartment model and iothalamate clearance detected in ARAS patients lower GFR in the stenotic compared to the contralateral and EH kidneys. GFRs measured by DCE-CT and iothalamate clearance showed a close match (r = 0.94, P<0.001, and mean difference 2.5±12.2mL/min). Inter-observer bias and variation in model-derived GFR (r = 0.97, P<0.001; mean difference, 0.3±7.7mL/min) were minimal. Renal perfusion by deconvolution agreed well with that by the compartment model when the blood transit delay from abdominal aorta to kidney was negligible. Conclusion The proposed two-compartment model faithfully depicts contrast dynamics using DCE-CT and may provide a reliable tool for measuring human single-kidney GFR and perfusion.
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Affiliation(s)
- Kai Jiang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Christopher M. Ferguson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Abdelrhman Abumoawad
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ahmed Saad
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Stephen C. Textor
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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Zhu R, Xu Z, Qi Z, Ye W, Wang J, Kong J, Jin J, Li J. How to diagnose renal artery stenosis correctly using ultrasound? Evaluation of results of renal arteries duplex ultrasonography examinations. Med Ultrason 2018; 20:298-305. [PMID: 30167582 DOI: 10.11152/mu-1341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM Renal artery duplex ultrasonography (RDU) is an effective and non-invasive screening test in diagnosing renal artery stenosis. The discordance of results in multiple RDU is common. We aim to evaluate the discordance and the reasons for discordance between diagnoses and measurements from multiple RDU examinations. MATERIAL AND METHOD A retrospective study was performed in 64 examinations of renal arteries from 32 patients that were referred for two or more RDU examinations and renal artery digital subtraction angiography (DSA) within six months, between August 2013 and January 2016. Using DSA as gold standard, we divided the renal arteries into three groups: discordant (one diagnosis of RDU was correct and one was wrong), misdiagnosed (neither RDU diagnosis was correct) and correct (both RDU diagnoses were correct) groups.We evaluated the discordance and reasons for discordance of diagnoses and measurements from multiple RDU examinations. Results: Among 64 renal arteries included in this study, 37 renal arteries had two correct diagnoses, 19 renal arteries had two discordant diagnoses, and eight renal arteries were misdiagnosed twice by RDU. The discordance of peak systolic velocity (PSV), the ratio between PSV in the renal artery with stenosis and PSV in the aorta (RAR), and tardus-parvus waveform measurements were clearly higher in the discordant diagnoses group than in the correctly diagnosed group. The most common reason for a discordant diagnosis was failure in obtaining correct tardus-parvus waveforms of the interlobar artery (26.31%). Themost common reason for misdiagnosis was the presence of an extremely severe stenosis with an atrophic kidney (31.25%). Overall, 87.50% of patients underwent RDU examinations had correct diagnoses of stenosis or occlusion at least once (including location and degree), as confirmed by DSA. CONCLUSIONS Our study indicates that standard operating procedures and improvements in examination technique by ultrasound doctors could reduce the discordance between multiple tests.
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Affiliation(s)
- Rong Zhu
- Department of Ultrasound, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Zhonghui Xu
- Department of Ultrasound, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Zhenhong Qi
- Department of Ultrasound, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - We Ye
- Department of Vascular Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Jian Wang
- Department of Ultrasound, First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China.
| | - Jing Kong
- Department of Ultrasound, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Jin Jin
- Department of Ultrasound, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital (PUMCH), Chinese Academe of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, 100730, China.
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Costache II, Costea CF, Fotea V, Rusu VL, Aursulesei V, Al Namat R, Costache DA, Dumitrescu N, Buzdugă CM, Dumitrescu GF, Sava A, Bogdănici CM. Morphological and functional renovascular changes as cause of resistant arterial hypertension - case report and literature review. Rom J Morphol Embryol 2018; 59:323-328. [PMID: 29940645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Resistant hypertension is defined by the inability to maintain within normal limits the blood pressure values of an individual, while he is under treatment with maximal tolerated doses of three antihypertensive agents. One of the most common types of resistant hypertension is renovascular hypertension (RVH), which is caused by the narrowing of the renal arteries, in the context of existing atherosclerotic plaques at that level. We are presenting the case of a hypertensive 56-year-old man admitted in the Clinic of Cardiology for a sudden rise of his blood pressure values, despite undergoing the scheduled treatment. The abdominal bruit discovered at the clinical examination and the hypokalemia, together with the mild impairment of the renal function raised the suspicion of an existing stenosis of the main renal blood vessels. Simple grey scale kidney ultrasound, Doppler ultrasound of the renal arteries, abdominal computed tomography and magnetic resonance angiography of the renal arteries, along with invasive renal angiography demonstrated a smaller right kidney, adrenal incidentalomas, reduced vascular diameter of renal arteries due to atheromatous lesions, thrombosis of the infrarenal segment of the abdominal aorta, and reduced vascular hemodynamics in the same territories. After the renal arteries revascularization and with minimal antihypertensive treatment, the patient had a favorable outcome, with normalization of blood pressure and renal function. Atherosclerotic disease causing renal artery stenosis is essential to be taken into consideration in the etiopathogenesis of resistant hypertension especially because RVH is a potentially curable disease.
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Affiliation(s)
- Irina Iuliana Costache
- Discipline of Ophthalmology, Department of Surgery II, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania; ; Clinic of Rehabilitation - Neurology, Rehabilitation Teaching Hospital, Iasi, Romania;
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Qiu C, Shao J, Liu X, Liu B. Utilizing flat-panel detector parenchymal blood volume imaging (FD-PBV) for quantitative kidney perfusion analysis during the process of percutaneous transluminal renal angioplasty (PTRA): A case report. Medicine (Baltimore) 2017; 96:e8654. [PMID: 29381939 PMCID: PMC5708938 DOI: 10.1097/md.0000000000008654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Traditional digital subtraction angiography (DSA) provides lumen morphology of renal artery as indicators for vascular patency in patients with renal artery stenosis (RAS). It, however, lacks hemodynamic information toward target kidney. To solve this shortcoming, a novel technique, flat-panel detector parenchymal blood volume imaging (FD-PBV), is introduced, which is able to evaluate hemodynamic changes of target kidney intraoperatively. PATIENTS CONCERNS A 77-year-old female presented with hypertension, intermittent dizziness, nausea, and fatigue. DIAGNOSES Ninety-nine percent stenosis of left RAS was found. INTERVENTIONS Percutaneous transluminal renal angioplasty was performed, along with FD-PBV acquisition protocol. OUTCOMES Her symptoms relieved gradually after procedure. Intuitive FD-PBV maps showed her renal perfusion improved remarkably. Quantitative analysis of FD-PBV showed her kidney volume was 47.02 and 75.61 cm with average density of contrast medium (CM) 58.1 HU and 311.5 HU before and after stenting. Follow-up at 6 months showed patency of the stent and stable kidney blood perfusion. LESSONS FD-PBV technique possesses a remarkable value in quantitatively assessing the changes of kidney blood perfusion and can be a useful auxiliary technique for DSA.
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Uchikawa H, Fujii K, Fujita M, Okunushi T, Shimojo N. Atypical moyamoya syndrome with brain calcification and stenosis of abdominal aorta and renal arteries. Brain Dev 2017; 39:710-713. [PMID: 28431773 DOI: 10.1016/j.braindev.2017.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/27/2017] [Accepted: 04/03/2017] [Indexed: 01/31/2023]
Abstract
Moyamoya syndrome is a progressive cerebrovascular disease that is characterized by stenosis of the terminal portion of the internal carotid artery and its main branches, in combination with an accompanying disease. We herein describe an 8-year-old boy exhibiting transient loss of consciousness, who had recurrent seizures in infancy with progressive brain calcification. On admission, he was alert but magnetic resonance angiography showed bilateral stenosis of the whole internal carotid artery and proliferation of vascular collaterals, and brain CT revealed calcification on bilateral putamen. Given that this fulfilled diagnostic criteria, we finally diagnosed him as having moyamoya syndrome, though the etiology was unclear. Interestingly, a whole vessel survey revealed vascular stenosis of abdominal aorta and renal arteries, in which the former has not been reported in moyamoya syndrome. We considered that brain calcification was gradually formed by decreased cerebral vascular flow from infancy, and stenosis of abdominal aorta was possibly extended from renal arteries. This is, moyamoya syndrome with brain calcification and stenosis of abdominal aorta, suggesting that morphological screening of whole vessels containing cerebral and abdominal arteries should be considered in cases of slowly progressive brain calcification.
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Affiliation(s)
- Hideki Uchikawa
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Pediatrics, Eastern Chiba Medical Center, Togane, Japan.
| | - Katsunori Fujii
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mayuko Fujita
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoko Okunushi
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
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Somalanka S, Harris FE, Chemla E, Suckling RJ, Swift PA. Spleno-renal artery transposition in a solitary functioning kidney for treatment-resistant hypertension and acute kidney injury. BMJ Case Rep 2017; 2017:bcr-2017-220438. [PMID: 28814591 DOI: 10.1136/bcr-2017-220438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Renal Artery Stenosis (RAS) is an important cause of treatment-resistant hypertension. Uncontrolled hypertension with RAS can cause progressive chronic kidney disease (CKD) leading to end-stage kidney disease. Therapeutic revascularisation can be helpful in appropriate circumstances where pharmaceutical intervention has failed and significant renovascular disease contributes to resistant hypertension. We present an interesting case of a Caucasian male with peripheral vasculopathy, abdominal aortic aneurysm (AAA), single functioning kidney and ostial RAS caused by stent struts from an endovascular AAA stent graft. He had escalating medications requirement, with repeated failed attempts at percutaneous radiological intervention that led to an episode of contrast-induced acute kidney injury (AKI), before undergoing successful surgical revascularisation by a splenic artery transposition graft to the left renal artery that was performed to improve kidney function and the blood pressure. This report highlights the challenges faced with regard to the management of severe hypertension and progressive CKD.
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Affiliation(s)
- Subash Somalanka
- Department of Nephrology, South West Thames Renal & Transplantation Unit, St Helier Hospital, Carshalton, UK
| | - Fiona E Harris
- Department of Nephrology, South West Thames Renal & Transplantation Unit, St Helier Hospital, Carshalton, UK
| | - Eric Chemla
- Department of Vascular Surgery, St George's Healthcare NHS Trust, London, UK
| | - Rebecca Jo Suckling
- Department of Nephrology, South West Thames Renal & Transplantation Unit, St Helier Hospital, Carshalton, UK
| | - Pauline A Swift
- Department of Nephrology, South West Thames Renal & Transplantation Unit, St Helier Hospital, Carshalton, UK
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Yeh R, Mohammed A, Margolin A, Schlossberg P, Ayyala RS. Abnormal renal parenchyma accumulation of 123I MIBG in a child with renal artery stenosis. Clin Imaging 2017; 46:20-23. [PMID: 28688242 DOI: 10.1016/j.clinimag.2017.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/25/2017] [Accepted: 06/29/2017] [Indexed: 11/18/2022]
Abstract
Hypertension is rare in the pediatric population, however renal artery stenosis (RAS) is an important cause that can be difficult to diagnose. Doppler ultrasound is the first line imaging modality, with computed tomography and magnetic resonance imaging as adjunct modalities, all with variable sensitivity for RAS. The gold standard for evaluation of RAS is invasive selective catheter angiography. We present a unique multimodality case of abnormal radiotracer uptake in the renal parenchyma on 123-Iodine metaiodobenzylguanidine (123I MIBG) scan in a patient with unilateral RAS. RAS is a potential cause of a false positive MIBG scan, and proper recognition may lead to accurate diagnosis.
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Affiliation(s)
- Randy Yeh
- Columbia University Medical Center/New York Presbyterian Hospital, Morgan Stanley Children's Hospital, New York, NY, United States.
| | - Ahmed Mohammed
- Columbia University Medical Center/New York Presbyterian Hospital, Morgan Stanley Children's Hospital, New York, NY, United States
| | - Aleksandr Margolin
- Columbia University Medical Center/New York Presbyterian Hospital, Morgan Stanley Children's Hospital, New York, NY, United States
| | - Peter Schlossberg
- Columbia University Medical Center/New York Presbyterian Hospital, Morgan Stanley Children's Hospital, New York, NY, United States
| | - Rama S Ayyala
- Columbia University Medical Center/New York Presbyterian Hospital, Morgan Stanley Children's Hospital, New York, NY, United States
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van Brussel PM, van de Hoef TP, de Winter RJ, Vogt L, van den Born BJ. Hemodynamic Measurements for the Selection of Patients With Renal Artery Stenosis: A Systematic Review. JACC Cardiovasc Interv 2017; 10:973-985. [PMID: 28521931 DOI: 10.1016/j.jcin.2017.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/27/2017] [Accepted: 02/12/2017] [Indexed: 11/25/2022]
Abstract
Interventions targeting renal artery stenoses have been shown to lower blood pressure and preserve renal function. In recent studies, the efficacy of catheter-based percutaneous transluminal renal angioplasty with stent placement has been called into question. In the identification of functional coronary lesions, hyperemic measurements have earned a place in daily practice for clinical decision making, allowing discrimination between solitary coronary lesions and diffuse microvascular disease. Next to differences in clinical characteristics, the selection of renal arteries suitable for intervention is currently on the basis of anatomic grading of the stenosis by angiography rather than functional assessment under hyperemia. It is conceivable that, like the coronary circulation, functional measurements may better predict therapeutic efficacy of percutaneous transluminal renal angioplasty with stent placement. In this systematic review, the authors evaluate the available clinical evidence on the optimal hyperemic agents to induce intrarenal hyperemia, their association with anatomic grading, and their predictive value for treatment effects. In addition, the potential value of combined pressure and flow measurements to discriminate macrovascular from microvascular disease is discussed.
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Affiliation(s)
- Peter M van Brussel
- Heart Center, Department of Interventional Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Tim P van de Hoef
- Heart Center, Department of Interventional Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Robbert J de Winter
- Heart Center, Department of Interventional Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Liffert Vogt
- Department of Nephrology, Academic Medical Center, Amsterdam, the Netherlands
| | - Bert-Jan van den Born
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
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O'Brien TJ, Roghanizad AR, Jones PA, Aardema CH, Robertson JL, Diller TE. The Development of a Thin-Filmed Noninvasive Tissue Perfusion Sensor to Quantify Capillary Pressure Occlusion of Explanted Organs. IEEE Trans Biomed Eng 2017; 64:1631-1637. [PMID: 28113229 DOI: 10.1109/tbme.2016.2615241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A new thin-filmed perfusion sensor was developed using a heat flux gauge, thin-film thermocouple, and a heating element. This sensor, termed "CHFT+," is an enhancement of the previously established combined heat flux-temperature (CHFT) sensor technology predominately used to quantify the severity of burns [1]. The CHFT+ sensor was uniquely designed to measure tissue perfusion on explanted organs destined for transplantation, but could be functionalized and used in a wide variety of other biomedical applications. Exploiting the thin and semiflexible nature of the new CHFT+ sensor assembly, perfusion measurements can be made from the underside of the organ-providing a quantitative indirect measure of capillary pressure occlusion. Results from a live tissue test demonstrated, for the first time, the effects of pressure occlusion on an explanted porcine kidney. CHFT+ sensors were placed on top of and underneath 18 kidneys to measure and compare perfusion at perfusate temperatures of 5 and 20 °C. The data collected show a greater perfusion on the topside than the underside of the specimen for the length of the experiment. This indicates that the pressure occlusion is truly affecting the perfusion, and, thus, the overall preservation of explanted organs. Moreover, the results demonstrate the effect of preservation temperature on the tissue vasculature. Focusing on the topside perfusion only, the 20 °C perfusion was greater than the 5 °C perfusion, likely due to the vasoconstrictive response at the lower perfusion temperatures.
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Fatic N, Kuzmanovic I, Markovic D, Davidovic L, Vukovic M, Kostić D. Kidney injury secondary to endovascular treatment of renal artery stenosis. Angiol Sosud Khir 2017; 23:159-163. [PMID: 28594810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this paper, we present a case of kidney injury as a complication of renal artery angioplasty in a 54-year-old female patient that suffered from resistant renovascular hypertension. This case emphasises the unpredictable nature of endovascular procedures, the need for careful post-procedure evaluation and the role of 'old fashioned' surgical techniques in resolving complications of endovascular procedures.
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Affiliation(s)
- N Fatic
- Department of vascular surgery, Clinic Center of Montenegro
| | - I Kuzmanovic
- Clinic for vascular and endovascular surgery, Clinic Center of Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - D Markovic
- Clinic for vascular and endovascular surgery, Clinic Center of Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - L Davidovic
- Clinic for vascular and endovascular surgery, Clinic Center of Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - M Vukovic
- Department of vascular surgery, Clinic Center of Montenegro
| | - D Kostić
- Clinic for vascular and endovascular surgery, Clinic Center of Serbia; Faculty of Medicine, University of Belgrade, Serbia
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Abstract
Renal artery disease produces a spectrum of progressive clinical manifestations ranging from minor degrees of hypertension to circulatory congestion and kidney failure. Moderate reductions in renal blood flow do not induce tissue hypoxia or damage, making medical therapy for renovascular hypertension feasible. Several prospective trials indicate that optimized medical therapy using agents that block the renin-angiotensin system should be the initial management. Evidence of progressive disease and/or treatment failure should allow recognition of high-risk subsets that benefit from renal revascularization. Severe reductions in kidney blood flow ultimately activate inflammatory pathways that do not reverse with restoring blood flow alone.
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Affiliation(s)
- Stephen C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA.
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Valle JA, Armstrong EJ, Waldo SW. Orbital Atherectomy in the Renal Artery: A New Frontier for an Emerging Technology? J Invasive Cardiol 2017; 29:E10-E12. [PMID: 28045673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Orbital atherectomy has been developed as a method to modify calcified plaque in the peripheral vasculature, with extensive experience and data supporting its use in infrainguinal peripheral arterial disease. However, calcific atherosclerotic disease occurs in other vascular beds and may benefit from the application of this technology. In this case report, we describe the first reported use of orbital atherectomy in a renal artery. A 55-year-old male with severe drug-refractory hypertension was found to have renal artery stenosis, with severe calcification of the right renal artery. Orbital atherectomy was utilized for initial plaque modification, and he underwent stenting of the renal artery lesion with an excellent angiographic and clinical result at follow-up. In conclusion, orbital atherectomy is a safe and effective means of plaque modification for severely calcified lesions. The safe and effective use of orbital atherectomy in the renal vasculature suggests an opportunity for ongoing evaluation into expanded roles for this technology beyond the coronary and lower-extremity arterial beds.
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Affiliation(s)
- Javier A Valle
- University of Colorado School of Medicine, 12361 East 17th Avenue, B130, Denver, CO 80045 USA.
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Abstract
Endovascular repair has emerged as a very important treatment modality in the management of a host of serious and relatively frequent thoracic aortic diseases. This minimally invasive approach is certain to revolutionize the entire field of thoracic aortic surgery in the near future. The technologies, however, can still be considered as a “work in progress.” Future refinements, which should be available within the next 1 to 2 years, will address some of the most important needs as yet unmet today: lower profile (<22 F) delivery systems, greater device flexibility, no longitudinal metal bars, and precise deliverability and deployment characteristics that will be conducive to optimal success and safety, especially in the region of the aortic arch.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Herz-Zentrum Bad Krozingen, Germany.
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31
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Abstract
Neonatal renal vascular thrombosis is rare but has devastating sequelae. The renal vein is more commonly affected than the renal artery. Most neonates with renal vein thrombosis present with at least one of the three cardinal signs, namely, abdominal mass, macroscopic hematuria and thrombocytopenia, while unilateral renal artery thrombosis presents with transient hypertension. Contrast angiography is the gold standard for diagnosis but because of exposure to radiation and contrast agents, Doppler ultrasound scan is widely used instead. Baseline laboratory tests for platelet count, prothrombin time, activated partial thromboplastin time and fibrinogen concentration are essential before therapy is initiated. Maternal blood is tested for lupus anticoagulant and anticardiolipin antibody. Evaluation for prothrombotic disorders is warranted when thrombosis is clinically significant, recurrent or spontaneous. Management should involve a multidisciplinary team that includes neonatologists, radiologists, pediatric hematologists and nephrologists. In addition to supportive therapy, recent guidelines recommend at least prophylactic heparin therapy in the majority of cases to prevent thrombus extension. Thrombolytic therapy is reserved for bilateral thrombosis compromising kidney function. Long-term sequelae, such as kidney atrophy, systemic hypertension and chronic kidney disease, are common, and follow-up by pediatric nephrologists is recommended for monitoring of kidney function, early detection and management of hypertension and chronic kidney disease.
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Affiliation(s)
- Lourdes Paula R Resontoc
- Shaw-NKF-NUH Children's Kidney Center, KTP-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Hui-Kim Yap
- Shaw-NKF-NUH Children's Kidney Center, KTP-National University Children's Medical Institute, National University Health System, Singapore, Singapore.
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Tower Block 12 #1E, Kent Ridge Road, Singapore, 119228, Singapore.
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Toyoda Y, Ozaki R, Kishi J, Hanibuchi M, Kinoshita K, Tezuka T, Goto H, Ono H, Nagai K, Bando Y, Doi T, Nishioka Y. An Autopsy Case of Aortic Intimal Sarcoma Initially Diagnosed as Polyarteritis Nodosa. Intern Med 2016; 55:3191-3195. [PMID: 27803418 PMCID: PMC5140873 DOI: 10.2169/internalmedicine.55.7152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A 61-year-old man had hypertension with stenosis in the left renal artery. When his fever, abdominal pain, and renal dysfunction progressed, he was admitted to our hospital. He was diagnosed with polyarthritis nodosa. His renal function rapidly deteriorated despite immunosuppressive therapy. His digestive tract perforated twice, and he subsequently died. An autopsy revealed that aortic intimal sarcoma caused stenosis in multiple arteries. Both polyarteritis nodosa and aortic intimal sarcoma are very rare diseases and the diagnoses are very difficult. It is very important to consider these entities when making a differential diagnosis of vasculitis.
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Affiliation(s)
- Yuko Toyoda
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
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Kinjo H, Kafa A. The results of treatment in renal artery stenosis due to Takayasu disease: comparison between surgery, angioplasty, and stenting. A monocentrique retrospective study. G Chir 2015; 36:161-7. [PMID: 26712071 DOI: 10.11138/gchir/2015.36.4.161] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate retrospectively and compare the long-term patency and the antihypertensive effect of open surgery, angioplasty, and stent insertion of the renal artery stenosis due to Takayasu's arteritis. PATIENTS AND METHODS We retrospectively analyzed and compared the effects on blood pressure and permeability of the renal artery over 23 patients (age ranging from 16 to 60 years, mean 33.9 years); with renovascular hypertension caused by Takayasu's arteritis. those patients underwent surgical treatment (11 arteries) or endovascular (19) including angioplasty (11) and stenting (8) for 30 stenotic renal arteries. RESULTS Technical success was 96.7% (29/30) without major complications (but longer period of hospitalization among patients who had surgery). In the last follow-up CT angiography (mean 60 ± 36 months), restenosis was 18.2% (2/11) in the surgery, 9% (1/11) in the angioplasty, and 62.5% (5/8) in the stenting. Rate of the permeability of the surgery was 100%, 90.9% , 81.8%, the permeability of the angioplasty was 100%, 90.9%, 90.9%, primary patency rate stenting was 62.5%, 37.5%, 37.5%, assists permeability was 87.5%, 75%, 50% at 1, 3 and 5 years, respectively. In the clinical follow-up (mean 60 ± 37.8 months, range 48-96 months) beneficial effects on blood pressure were achieved into 91.3% of patients (21/23), and there was no significant difference between patients who have been treated by surgery and angioplasty alone and the patients who received a stent in at least one renal artery. CONCLUSION Angioplasty has shown better long-term patency and a similar clinical benefit of renovascular hypertension in renal artery stenosis caused by Takayasu's arteritis compared with the surgery and the stenting. We suggest that stenting should be reserved in case of clear failure of the angioplasty. The surgery is our choice for patients who do not meet the indication of endovascular treatment or failure of this treatment.
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34
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Hausberg M. [Three clinical cases of hypertension]. MMW Fortschr Med 2015; 157:40. [PMID: 26953406 DOI: 10.1007/s15006-015-3727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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35
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Salsamendi J, Pereira K, Baker R, Bhatia SS, Narayanan G. Successful technical and clinical outcome using a second generation balloon expandable coronary stent for transplant renal artery stenosis: Our experience. J Radiol Case Rep 2015; 9:9-17. [PMID: 26629289 DOI: 10.3941/jrcr.v9i10.2535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Transplant renal artery stenosis (TRAS) is a vascular complication frequently seen because of increase in the number of renal transplantations. Early diagnosis and management is essential to optimize a proper graft function. Currently, the endovascular treatment of TRAS using angioplasty and/or stenting is considered the treatment of choice with the advantage that it does not preclude subsequent surgical correction. Treatment of TRAS with the use of stents, particularly in tortuous transplant renal anatomy presents a unique challenge to an interventional radiologist. In this study, we present three cases from our practice highlighting the use of a balloon-expandable Multi-Link RX Ultra coronary stent system (Abbott Laboratories, Abbott Park, Illinois, USA) for treating high grade focal stenosis along very tortuous renal arterial segments. Cobalt-Chromium alloy stent scaffold provides excellent radial force, whereas the flexible stent design conforms to the vessel course allowing for optimal stent alignment.
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Affiliation(s)
- Jason Salsamendi
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida, USA
| | - Keith Pereira
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida, USA
| | - Reginald Baker
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida, USA
| | - Shivank S Bhatia
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida, USA
| | - Govindarajan Narayanan
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida, USA
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36
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Mousa AY, AbuRahma AF, Bozzay J, Broce M, Bates M. Update on intervention versus medical therapy for atherosclerotic renal artery stenosis. J Vasc Surg 2015; 61:1613-23. [PMID: 26004332 DOI: 10.1016/j.jvs.2014.09.072] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/09/2014] [Indexed: 11/16/2022]
Abstract
Atherosclerotic renal artery stenosis is known to be one of the most common causes of secondary hypertension, and early nonrandomized studies suggested that renal artery stenting (RASt) improved outcomes. The vascular community embraced this less invasive treatment alternative to surgery, and RASt increased in popularity during the late 1990s. However, recent randomized studies have failed to show a benefit regarding blood pressure or renal function when RASt was compared with best medical therapy, creating significant concerns about procedural efficacy. In the wake of these randomized trial results, hypertension and renal disease experts along with vascular interventional specialists now struggle with how to best manage atherosclerotic renal artery stenosis. This review objectively analyzes the current literature and highlights each trial's design weaknesses and strengths. We have provided our recommendations for contemporary treatment guidelines based on our interpretation of the available empirical data.
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Affiliation(s)
- Albeir Y Mousa
- Department of Surgery, West Virginia University, Charleston, WVa.
| | - Ali F AbuRahma
- Department of Surgery, West Virginia University, Charleston, WVa
| | - Joseph Bozzay
- Department of Surgery, West Virginia University, Charleston, WVa
| | - Mike Broce
- CAMC Health Education and Research Institute, Charleston, WVa
| | - Mark Bates
- Department of Surgery, West Virginia University, Charleston, WVa
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37
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Lantelme P, Harbaoui B, Courand PY. [Renal artery stenosis]. Rev Prat 2015; 65:822-826. [PMID: 26298908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Renal artery stenosis (RAS) is found in 1 to 2% of all hypertensive patients. Its diagnosis involves as a first step Doppler ultrasound and as a confirmatory test, CT scan or MRI. When the diagnosis isconfirmed, three questions should be addressed by the clinician: 1) the anatomical orm that is, fibromuscular dysplasia (FD) or atherosclerotic RAS (ARAS); 2) the potential relation between RAS and hypertension with major differences according to the two main etiologies; in the presence of FD hypertension is a priorir elated to the stenosis while it is not the case with ARAS; 3) is there an indication for revascularization with again two opposite situations. Renal angioplasty may cure up to one third of patients with FD and improve blood pressure control in some others and has thus to be discussed in this clinical context. On the contrary, several randomized trials have shown that the blood pressure benefit of renal revascularization is limited if any in ARAS and, above all, not associated with an improvement of cardiovascular and renal outcomes. Renal angioplasty should thus be restricted to highly selected patients while in all cases, cardiovascular prevention should be intensified, based on renin angiotensin system blockers, statins, and aspirin use. Whatever the management, these patients should be followed both on the renal side to detect restenosis or renal impairment, and on other cardiovascular complications particularly in the presence of ARAS.
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38
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Salvetti A, Arzilli F, Parrucci M, Fommei E, Napoli V, Zampa V, Bartolozzi C. Renal artery stenosis in the nineties: screening dilemmas. Contrib Nephrol 2015; 119:45-53. [PMID: 8783590 DOI: 10.1159/000425448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A Salvetti
- Cattedra di Medicina Interna, Clinica Medica I, University of Pisa, Italy
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39
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Affiliation(s)
- P Zucchelli
- Malpighi Department of Nephrology, Policlinico S. Orsola-Malpighi, Bologna, Italy
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40
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Farmelant MH, Burrows BA. Sensitivity and specificity of radioisotope renography in renovascular hypertension. Contrib Nephrol 2015; 11:105-9. [PMID: 699574 DOI: 10.1159/000401786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Effective drug therapy for hypertension modifies the urgency of establishing a diagnosis of renal arterial stenosis. The cost of establishing a diagnosis must be considered with other factors in determining the usefulness of renography in renovascular hypertension. Recently published studies estimate the cost effectiveness of this procedure based on some data from a cooperative study of renal vascular hypertension. The small but costly incidence of false positives contributes significantly to the total cost of patient screening. Careful attention to technical details that are presented here could reduce false positives without sacrificing the true positives. However, even with increased specificity economic considerations would indicate limiting a screening program to younger patients or those in whom a drug regimen is unsuccessful.
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41
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Kletter K, Mostbeck G, Duczak R. Captopril renography and duplex sonography: comparison of two noninvasive methods for the diagnosis and follow-up in renovascular hypertension. Contrib Nephrol 2015; 79:190-5. [PMID: 2225859 DOI: 10.1159/000418176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- K Kletter
- First Medical Department, University of Vienna, Austria
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42
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Meurer KA, Tauchert M, Schröder A. Renin activity, renin secretion rate and renal hemodynamics as functional tests renovascular hypertension. Contrib Nephrol 2015; 3:38-44. [PMID: 1026368 DOI: 10.1159/000399379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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43
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Dietz R. Renovascular hypertension. Contrib Nephrol 2015; 43:129-43. [PMID: 6237882 DOI: 10.1159/000409948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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44
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Erwin PA, Goel SS, Gebreselassie S, Shishehbor MH. Restoration of renal allograft function via reduced-contrast percutaneous revascularization of transplant renal artery stenosis. Tex Heart Inst J 2015; 42:80-3. [PMID: 25873808 DOI: 10.14503/thij-13-4059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transplant renal artery stenosis (TRAS), the most common vascular complication of kidney transplantation, can lead to heart failure, uncontrolled hypertension, and irreversible dysfunction of the transplanted kidney. Percutaneous revascularization can improve outcomes in well-selected patients with symptomatic TRAS, but the intervention itself poses risk to the transplanted kidney because of the quantities of nephrotoxic contrast solution that often are used. We report the case of a patient with TRAS who, 5 months after undergoing a kidney transplant, developed allograft dysfunction and heart failure that required hemodialysis. We performed angioplasty and stenting of the TRAS, using intravascular ultrasonography and fluoroscopy as our primary imaging methods. To minimize further damage to a potentially viable kidney, the volume of intravascular contrast medium used was trivial (a total of 9 cc). Revascularization of the patient's TRAS restored his renal function: within 4 weeks of the procedure, he no longer needed hemodialysis, and his heart failure symptoms had resolved. This case emphasizes the value of early definitive treatment of TRAS and the usefulness of intravascular ultrasonography to minimize the amount of contrast medium used in endovascular procedures.
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45
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Iaitskiĭ NA, Zverev OG, Volkov AB, Riabikov MA, Bedrov AI, Voĭnov AV. [Restoration of renal blood flow and excretory function after successful revascularization in chronic renal artery occlusion]. Vestn Khir Im I I Grek 2015; 174:101-102. [PMID: 26234076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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46
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Abstract
Atherosclerotic renal artery stenosis can cause ischaemic nephropathy and arterial hypertension. Renal artery stenosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Many patients with RAS may be managed effectively with medical therapy for several years without endovascular stenting, as demonstrated by randomized, prospective trials including the cardiovascular outcomes in Renal Atherosclerotic Lesions (CORAL) trial, the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial. These trials share the limitation of excluding subsets of patients with high-risk clinical presentations, including episodic pulmonary edema and rapidly progressing renal failure and hypertension. Blood pressure control and medication adjustment may become more difficult with declining renal function and may prevent the use of angiotensin receptor blocker and angiotensin-converting enzyme inhibitors. The objective of this review is to evaluate the current management of RAS for cardiologists in the context of recent randomized clinical trials. There is now interest in looking more closely at patient selection for intervention, with focus on intervening only in patients with the highest-risk presentations such as flash pulmonary edema, rapidly declining renal function and severe resistant hypertension.
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Affiliation(s)
- A Sauguet
- Clinique Pasteur, 45, avenue de Lombez, 31076 Toulouse, France.
| | - B Honton
- Clinique Pasteur, 45, avenue de Lombez, 31076 Toulouse, France.
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47
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Karacabey S, Hocagil H, Sanri E, Hocagil AC, Ardic S, Suman E. No suspicion, no disease! renal infarction: case series. Urol J 2014; 11:1984-1986. [PMID: 25433479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 10/21/2014] [Indexed: 06/04/2023]
Affiliation(s)
- Sinan Karacabey
- Department of Emergency Medicine, Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Hilal Hocagil
- Department of Emergency Medicine, Bülent Ecevit University, Faculty of Medicine, Zonguldak, Turkey
| | - Erkman Sanri
- Department of Emergency Medicine, Sanliurfa Mehmet AkifInan Education and Research Hospital, Şanliurfa, Turkey
| | - Abdullah Cuneyt Hocagil
- Department of Emergency Medicine, Bülent Ecevit University, Faculty of Medicine, Zonguldak, Turkey.
| | - Senol Ardic
- Department of Emergency Medicine, Trabzon Kanuni Education and Research Hospital, Trabzon, Turkey
| | - Enes Suman
- Department of Emergency Medicine, RecepTayyip Erdogan University, Education and Research Hospital, Rize, Turkey
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48
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Shejul YK, Viswanathan MK, Jangale P, Kulkarni A. Fibromuscular dysplasia: a cause of secondary hypertension. Korean J Intern Med 2014; 29:840-1. [PMID: 25378988 PMCID: PMC4219979 DOI: 10.3904/kjim.2014.29.6.840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/01/2014] [Accepted: 09/03/2014] [Indexed: 11/27/2022] Open
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49
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Hall ME, Rocco MV, Morgan TM, Hamilton CA, Edwards MS, Jordan JH, Hurie JB, Hundley WG. Chronic diuretic therapy attenuates renal BOLD magnetic resonance response to an acute furosemide stimulus. J Cardiovasc Magn Reson 2014; 16:17. [PMID: 24490671 PMCID: PMC3914363 DOI: 10.1186/1532-429x-16-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/29/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Blood Oxygen Level Dependent (BOLD) magnetic resonance (MR) is a novel imaging tool that detects changes in tissue oxygenation. Increases in renal oxygenation in response to a standard 20 mg intravenous furosemide stimulus have been evaluated to assess kidney viability in patients with renal artery stenosis (RAS). The effect of prior exposure to furosemide on the ability of BOLD MR techniques to evaluate renal function is unknown.This study tested the hypothesis that chronic loop diuretic therapy is associated with attenuated responses in renal tissue oxygenation as measured by BOLD MR with an acute 20 mg intravenous furosemide stimulus in participants undergoing evaluation for RAS. METHODS Thirty-eight participants referred for evaluation of RAS were recruited for this study. We examined renal cortical and medullary BOLD signal (T2*) intensities before and after a 20 mg intravenous furosemide stimulus. Additionally, we measured changes in renal artery blood flow using phase contrast techniques. RESULTS After controlling for covariates age, race, gender, diabetes, glomerular filtration rate, body mass index, and stenosis severity, daily oral furosemide dose was an independent, negative predictor of renal medullary T2* response (p=0.01) to a standard 20 mg intravenous furosemide stimulus. Stenosis severity and ethnicity were also significant independent predictors of changes in T2* signal intensity in response to an acute furosemide challenge. Changes in renal blood flow in response to acute furosemide administration were correlated with changes in T2* in the renal cortex (r=0.29, p=0.03) but not the medulla suggesting changes in renal medullary oxygenation were not due to reduced renal medullary blood flow. CONCLUSIONS Chronic furosemide therapy attenuates BOLD MR responses to an acute furosemide stimulus in patients with RAS being evaluated for renal artery revascularization procedures. Thus, patients who are chronically administered loop diuretics may need a different dosing strategy to accurately detect changes in renal oxygenation with BOLD MR in response to a furosemide stimulus.
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Affiliation(s)
- Michael E Hall
- Department of Medicine, Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael V Rocco
- Department of Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| | - Timothy M Morgan
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| | - Craig A Hamilton
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| | - Matthew S Edwards
- Department of Vascular Surgery, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| | - Jennifer H Jordan
- Department of Medicine, Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| | - Justin B Hurie
- Department of Vascular Surgery, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| | - W Gregory Hundley
- Department of Medicine, Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, USA
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
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Shakhov BE, Ivanov LN, Kuz'menko EA, Katynov VV. [Revascularization of the myocardium and kidneys in patients with combined atherosclerotic lesions of coronary and renal arteries]. Angiol Sosud Khir 2014; 20:118-127. [PMID: 25490366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The study included a total of 109 patients presenting with combined atherosclerotic lesions of coronary and renal arteries. Depending on severity of angina pectoris, the patients were subdivided into two groups. Group One consisted of patients subjected to revascularization of the myocardium and kidneys, and Group Two comprised those with a dominating clinical picture of vasorenal hypertension syndrome and undergoing surgery on renal arteries alone. Combined revascularizations were carried out in 31 patients. Of these, five underwent single-stage endovascular interventions on coronary and renal arteries. Isolated interventions were performed in 78 patients. Selectivity of revascularisations of vascular basins was determined first of all by the degree of coronary impairments, arterial hypertension, and the presence of chronic renal failure. No cases of hospital lethality were registered. The 10-year survival rate after renal revascularization amounted to 80.1%, after combined operations to 90.9%. In the immediate postoperative period improvement following isolated renal revascularization was achieved in 62 (86.1%) patients, after isolated coronary artery bypass grafting and combined operation - in all patients. The long-term outcomes turned out to be better after combined operations (80.0%) as compared to those after isolated operations on renal arteries (70.3%).
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