title: Two cases of renovascular hypertension and ischemic renal dysfunction: reliable choice of examinations and treatments.
abstract: We experienced two aged patients with atherosclerotic renovascular stenosis associated with hypertension and ischemic nephropathy. Both patients exhibited sudden rise in blood pressure (BP) and progressive aggravation of renal dysfunction. In these patients, the use of contrast medium to screen for renal artery stenosis (RAS) ran the risk of further deterioration of renal function. We therefore used magnetic resonance angiography (MRA), which is less conducive to renal damage, to screen for RAS. One-sided RAS was treated by percutaneous transluminal angioplasty of the renal artery (PTRA) and stenting. As a result, BP decreased in both patients. Serum creatinine (Cr) decreased slightly in one patient, whereas, in the other, serum Cr increased transiently and then decreased and stabilized to pre-treatment levels. Thus, although it is unclear whether the combination of PTRA and stenting is among the best treatments for patients with RAS and moderate-to-severe renal dysfunction, PTRA and stenting are clearly of benefit in selected patients. In addition, recent progress in characterizing the pathophysiology of ischemic nephropathy associated with renovascular hypertension has created interest in the therapeutic potential of angiotensin II receptor antagonists, sympatholytic agents, and antioxidants. Therefore, we discuss the therapeutic utility of PTRA and stenting and the above-mentioned medications in patients with RAS and renal dysfunction.
authors.affiliation: Department of Nephrology and Endocrinology, Faculty of Medicine, University of Tokyo, Hongo, Tokyo, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Ando
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Takahashi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Shibata
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Matsui
authors.forename: Megumi
authors.initials: M
authors.lastname: Fujita
authors.forename: Yugo
authors.initials: Y
authors.lastname: Shibagaki
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Shimosawa
authors.forename: Masashi
authors.initials: M
authors.lastname: Isshiki
authors.forename: Toshiro
authors.initials: T
authors.lastname: Fujita
mesh_terms: D000800:Angioplasty, Balloon; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology* / Q000628:therapy; D007511:Ischemia / Q000150:complications*; D007668:Kidney / Q000098:blood supply* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000150:complications* / Q000628:therapy; D015607:Stents
chemical_list: D000959:Antihypertensive Agents