Efficacy of Renal Revascularization in a Patient With Fibromuscular Renal Artery Stenosis and Heart Failure

Abstract

SummaryWe report the case of a 65-year-old woman with a solitary kidney who developed hypertension due to renal artery stenosis caused by fibromuscular dysplasia. In addition, an echocardiogram revealed severe left ventricular systolic and diastolic dysfunction. Despite antihypertensive drug treatment that included diuretics, her serum concentration of brain natriuretic peptide was persistently elevated and associated with progressive worsening of renal function. She underwent iliac artery to renal artery bypass grafting. After the surgery, blood pressure control was good, the serum concentration of brain natriuretic peptide decreased, and left ventricular diastolic function improved. This case exemplifies the efficacy of renal revascularization in patients with fibromuscular renal artery stenosis and heart failure. (Int Heart J 2010; 51: 432-435) Key words: Fibromuscular dysplasia, Renal artery stenosis, Heart failure, Renal revascularization F ibromuscular dysplasia (FMD) is an idiopathic, nonatherosclerotic disease of the musculature of arterial walls that leads to the narrowing of the arterial lumen. 1) FMD is the most frequent cause of renal artery stenosis (RAS) after atherosclerosis. RAS often results in difficult-to-control hypertension, especially in patients with bilateral RAS or its equivalent, RAS in a solitary functioning kidney. In patients with RAS, renal revascularization by percutaneous transluminal angioplasty or surgical reconstruction is indicated to cure hypertension or to improve blood pressure control.2-4) Atherosclerotic RAS, which is the most frequent type of RAS and more common in the elderly, is reported to be associated with frequent abnormalities of left ventricular (LV) function and episodes of heart failure, often mediated through labile systemic hypertension and exacerbation of myocardial ischemia. Many of those patients with atherosclerotic RAS and heart failure have been reported to benefit from renal revascularization for the control of blood pressure and also heart failure. 5) In contrast, FMD is more common among females and most cases of FMD correspond to patients younger than 50 years. There have been few reports describing patients with RAS caused by FMD who presented congestive heart failure, and the outcome of renal revascularization in those patients was not clear. Here, we describe the case of a 65-year-old woman with a solitary kidney and hypertension due to RAS caused by FMD who also had LV dysfunction. The patient underwent surgical renal revascularization, which led to good control of blood pressure as well as an improvement of cardiac functioning. Case ReportThe patient was 65 years old at the time of admission. She had developed hypertension at the age of 17, and 8 years later she had undergone surgical reconstruction using a bypass graft of the left renal artery due to stenosis caused by FMD. However, the bypass graft became occluded after the procedure, and nephrectomy of her left kidney was performed.At age 60, she was referred to our hospital again for the...

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

“…14–16 In addition, multiple case reports describe beneficial responses after renal revascularization therapy. 17–23 One can postulate that there must be a subgroup of patients with a symptomatic RAS who will benefit from revascularization. Therefore, identification of prognostic parameters for a positive response after revascularization might improve patient selection and efficacy of revascularization therapy in patients with RAS.…”

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

“…Although pathology has revealed FMD's nonatherosclerotic and noninflammatory nature, an intra‐arterial angiogram still remains the gold standard for diagnosis . In our case, angiography discovered the solitary right kidney as well as FMD‐mediated focal and tubular narrowing affecting both upper and lower branches of the right renal artery.…”