Congenital Solitary Kidney With Renovascular Hypertension Diagnosed by Means of Captopril-enhanced Renography and Magnetic Resonance Angiography

Abstract

SUMMARYA 24 year-old woman had a congenital solitary kidney with renovascular hypertension due to fibromuscular dysplasia. She had been treated as having essential hypertension until she developed preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome at 28 weeks of gestation. Plasma renin activity and captopril test results did not indicate any abnormalities. However, renography revealed captoprilinduced deterioration. Magnetic resonance angiography was also useful to detect renal artery stenosis. These findings were confirmed by renal angiography. After successful percutaneous transluminal renal angioplasty, her blood pressure and the pattern of captopril renography normalized. (Int Heart J 2005; 46: 347-353) Key words: Captopril renography, Fibromuscular dysplasia, HELLP syndrome, Magnetic resonance angiography, Renovascular hypertension, Solitary kidney RENAL artery stenosis in a patient with a solitary kidney is relatively rare. As these patients are at a high risk of developing renal insufficiency, 1) accurate assessment of the renal blood supply is essential. While angiography provides the best imaging of renal arteries and remains the gold standard, it cannot evaluate renal function and is not completely risk-free. Captopril renography, which can be used to assess the response of each of the renal functions to the renin-angiotensin system, detects renovascular hypertension (RVHT) with high sensitivity and specificity. [2][3][4] This test is also considered useful for patients with a solitary kidney, although the extent to which hypertension and renal function depend on renin is still controversial. 5) We report here a patient with a congenital solitaryFrom the

Fibromuscular Dysplasia Affecting a Two‐Branched Renal Artery in a Patient With a Solitary Kidney: Case Presentation

“…The most common manifestation of renal artery FMD is treatment-resistant renovascular hypertension (RVHT), which depicts the causal relationship between confirmed renal arterial narrowing and elevated blood pressure. 1,7,13 In our case, the young individual initially presented with treatment-resistant uncontrolled hypertension. It is estimated that renal artery FMD accounts for nearly 10% of all RVHT causes.…”

Gynaecologic Nephrology

“…Diagnosis is suspected by presence of treatment resistant hypertension and can be confirmed by magnetic resonance imaging. It is usually treated with angioplasty and stent placement during second and third trimester of pregnancy (Hayashida et al, 2005). Pheochromocytoma can be associated with high maternal and neonatal morbidity and mortality but usually is diagnosed at time of delivery due to onset of severe hypertensive crisis.…”

Pregnancy and the Kidney

“…Hypertension that is severe and resistant to therapy in the 1st and 2nd trimesters of pregnancy should alert the clinician to the possibility of a secondary cause of hypertension. Angioplasty and stent placement in the 2nd and 3rd trimesters of pregnancy after diagnosis by magnetic resonance angiography (MRA) have been described (Hayashida et al, 2005). Atherosclerosis is more common in men with late-onset hypertension, but 80% of patients with fibromuscular dysplasia are women of child-bearing age (Simon et al, 1972).…”