Successful angioplasty during pregnancy for renal artery stenosis

Abstract

Renal artery stenosis can be diagnosed during pregnancy and treated at the same time. A 30-year-old woman had a sudden, severe but asymptomatic hypertensive crisis at 21 weeks of gestation. The diagnosis of renal artery stenosis suspected on Doppler ultrasonography was confirmed and treated by renal angioplasty, which reduced her blood pressure. At 27 weeks of gestation, her blood pressure increased again, associated with significant proteinuria, suggesting pre-eclampsia. A cesarean section was performed giving birth to a healthy 940-g child. Renal artery stenosis should be considered when sudden and early-onset hypertension appears during pregnancy.

Renal artery stenosis presenting as preeclampsia

“…In terms of invasive treatment, percutaneous transluminal renal angioplasty with or without stenting has become the standard versus surgical revascularization. Although a recent systematic review showed only marginal benefit to this approach compared to medical therapy alone, there is evidence that select patient do have significant benefits in blood pressure control [2,8,9]. Furthermore, studies have shown that usually at least 80% stenosis is required to produce any significant hemodynamic stimulus to the renin-angiotensin system and thus may be a threshold for invasive treatment [10,11].…”

“…When possible, expedited delivery is beneficial. However, there has been some success with interventional treatment prior to delivery [2]. The high mortality risk of eclampsia continues into the the postpartum period and it is uncertain when blood pressures can be expected to normalize in preeclampsia even in the absence of renovascular hypertension [12].…”

“…Classic presentations include chronic refractory hypertension, recurrent flash pulmonary edema and renal insufficiency after initiation of an angiotensin converting enzyme inhibitor. Although rare, there have also been reported cases of pregnant patients presenting with new onset or superimposed preeclampsia secondary to renovascular hypertension [1,2]. In this subset of patients, renovascuar hypertension carries significantly higher risks including obstetric, fetal and medical emergencies and death.…”