Reversible renin-dependent renovascular hypertension successfully treated with percutaneous transluminal renal angioplasty and stenting.
A 37-year old woman was suspected of having renovascular hypertension because of recent onset severe hypertension (blood pressure 220/135 mmHg; compared to 132/65 mmHg two years earlier) and an abdominal bruit. A captopril renal scan indicated the presence of right renal artery stenosis. Additionally, a captopril plasma renin activity (PRA) provocation test showed a positive result for renovascular hypertension (baseline PRA = 291 microU/mL; 1 hour post-captopril PRA = 1444 microU/mL). Selective renal angiography demonstrated a severe critical stenotic lesion at the distal portion of the right renal artery. Blood pressure (BP) decreased to 136/80 mmHg one day after successful percutaneous transluminal renal angioplasty and stenting. Repeat renal angiography six months after the procedure revealed no evidence of in-stent restenosis. Blood pressure (BP = 137/76 mmHg) and plasma renin profile (baseline PRA = 23.8 microU/mL; 1 hour post-captopril PRA=22.3 microu/mL) also were normal six months following initial revascularization. Moreover, blood pressure (137/84 mmHg) and renin profile remained normal 2.5 years after the procedure (baseline PRA = 24.3 microU/mL; 1 hour post-captopril = 25.6 microU/mL). The results of this study have thus demonstrated a case of renin-dependent renovascular hypertension in which both the blood pressure and plasma renin activity profile normalized following successful percutaneous transluminal angioplasty and stenting.
Fang
Ber-Ren
BR
Division of Cardiology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China.
Lin
Chin-Yew
CY
D000328:Adult; D000800:Angioplasty, Balloon / Q000379:methods*; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000097:blood / Q000628:therapy*; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging; D012078:Renal Artery Obstruction / Q000150:complications / Q000000981:diagnostic imaging; D012083:Renin / Q000097:blood*; D015607:Stents
D012083:Renin