Successful Depressor Effect Concomitant with Complete Normalization of High Renin and Aldosterone Profile by Percutaneous Transluminal Renal Angioplasty in a Patient with Acute Exacerbated Heart Failure with Preserved Ejection Fraction

Abstract

Unusual or unexpected effect of treatment Background: Although the effect of percutaneous transluminal renal angioplasty (PTRA) on clinical outcomes has not been established in previous clinical studies, some case reports showed that PTRA drastically improved patient outcomes. The appropriateness of PTRA should be discussed in detail. Case Report: A 59-year-old man had been on treatment for hypertension for 5 years, but his blood pressure (BP) had been poorly controlled for the past 5 months. He was hospitalized for pulmonary edema due to heart failure with preserved ejection fraction (HFpEF). During hospitalization, ultrasound and plain computed tomography revealed atrophy of the right kidney, and laboratory investigations indicated secondary aldosteronism with high plasma renin activity (PRA). Unenhanced magnetic resonance imaging (MRI) suggested severe stenosis or occlusion of the right renal artery. PTRA was performed for total occlusion at the origin of the right renal artery, resulting in favorable dilation of the vessel and good blood flow. A differential renal vein renin assay showed a right-left difference of PRA before PTRA, but this disappeared after the procedure. Both PRA and the plasma aldosterone concentration were normalized after PTRA. In addition, the patient's BP decreased, proteinuria was reduced, diuretics could be discontinued, and his calcium channel blocker dosage was decreased. Conclusions: The present case suggests that screening for renal artery stenosis by unenhanced MRI may be useful in patients who have HFpEF because PTRA can be used to achieve marked improvement of hypertension, endocrine abnormalities, and heart failure if stenosis is detected.

Treatment of Refractory Hypertension with Timely Angioplasty in Total Renal Artery Occlusion with Atrophic Kidney

“…Although the current expert consensus states that PTRA for ARVD with advanced atrophic kidney and/or chronic total occlusion is rarely appropriate (11), several case studies have reported a positive outcome in such patients (16)(17)(18)(19)(20). In the present case, the occlusive lesion appeared to progress during the time when hypertension had suddenly worsened.…”

“…Angioplasty was performed four months after the onset of the deterioration of hypertension. In previous case reports as well, angioplasty achieved favorable blood pressure control in patients with advanced atrophic kidney who presented with a sudden deterioration of blood pressure control, and PTRA was performed within six months after the onset of the episode ( 18 , 19 ). When the sudden onset of hypertension or deterioration of blood pressure control leads to the diagnosis of ARVD, the involvement of a stenotic/occlusive lesion is very likely the cause of the blood pressure elevation.…”