A Case of Renovascular Hypertension with Marked Polyuria after Percutaneous Transluminal Renal Angioplasty

Abstract

A 43-year-old female patient with hypertension was diagnosed as having one-kidney renovascular hypertension with dysfunction of the contralateral kidney, and percutaneous transluminal renal angioplasty was carried out. Marked polyuria was observed during the 2- to 72-hour postoperative period. During the 12- to 18-hour period of polyuria, the urine volume was 8.9 liters/6 h, which was 62% of the glomerular filtration, and was accompanied by high fractional excretion of sodium and of potassium and a high urine β₂-microglobulin level. The mechanism of polyuria in this case is discussed.

Exaggerated natriuresis after renal artery balloon angioplasty for flash pulmonary oedema: a potential complication in one-kidney renovascular hypertension

“…We could not attribute polyuria to acute tubular necrosis (ATN), as diuresis was normal in the days preceding the angiography. Furthermore, it appears unlikely that ATN occurred in the above mentioned previously reported patients with stable chronic hypertension who developed polyuria after elective renal artery revascularization [10][11][12][13]. We found no signs that other osmols induced polyuria, as osmol and glucose levels were within normal range and blood urea concentration was only moderately increased (maximum 31 mmol/l).…”

“…Diabetes insipidus was considered unlikely, as serum sodium levels remained within normal range. Moreover, in a previously reported case, levels of antidiuretic hormone were normal and vasopressin administration did not affect polyuria [10]. Therefore, it appears likely that other mechanisms are involved in the development of polyuria.…”

“…We found only six previous reports (published between 1961 and 1996) on a total of 16 patients who developed marked polyuria after renal artery revascularization [10–13]. Two of these reports were only published in the Japanese language and not accessible, but these reports were summarized in one of the other case reports [10]. These 16 patients underwent either surgical renal angioplasty ( n = 4), aortorenal bypass ( n = 9), splenorenal anastomosis ( n = 2) or percutaneous balloon angioplasty ( n = 1) for longstanding hypertension due to ARAS ( n = 9), fibromuscular dysplasia (FMD, n = 5), aortitis ( n = 1) or renal artery stenosis of unspecified cause ( n = 1).…”

“…We searched PubMed and Google Scholar with the key words 'polyuria', 'severe diuresis' or 'natriuresis' and 'renal artery stenosis', 'renovascular hypertension' or 'fibromuscular dysplasia' or 'renal arteryangioplasty' and searched reference lists of papers on this topic. We found only six previous reports (published between 1961 and 1996) on a total of 16 patients who developed marked polyuria after renal artery revascularization [10][11][12][13]. Two of these reports were only published in the Japanese language and not accessible, but these reports were summarized in one of the other case reports [10].…”

“…The similarity between our case and all these previous reports appears to be the fact that all patients had only one functioning kidney. In all cases, the contralateral kidney was either removed before or nonfunctioning due to contraction, chronic ischemia or aplasia [10][11][12][13]. To the best of our knowledge, no cases of postrevascularization polyuria have been reported in patients with a functioning contralateral kidney.…”