title: Renovascular hypertension: a unique cause of unilateral focal segmental glomerulosclerosis.
abstract: A 48-year-old man presented with malignant hypertension and massive proteinuria. Renal angiography showed complete obstruction of the left renal artery and 99mTc-mercaptoacetylglycine (MAG3) renography showed a nonfunctioning left kidney. Percutaneous transluminal renal angioplasty of the left renal artery was unsuccessful; hence, the patient underwent left nephrectomy because of uncontrolled hypertension and proteinuria. Histological examination of a right kidney specimen revealed lesions of focal segmental glomerulosclerosis with benign nephrosclerosis. In contrast, histology of the left kidney showed typical ischemic kidney with hypertrophy of arteriolar smooth muscle cells. The patient responded favorably to the nephrectomy, as his blood pressure and urinary protein dramatically decreased with no antihypertensive medication. This case illustrates the heterogeneous effect of the renin-angiotensin system on either kidney in patients with renovascular hypertension due to unilateral renal artery stenosis.
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Bassam
authors.initials: B
authors.lastname: Alchi
authors.forename: Arimasa
authors.initials: A
authors.lastname: Shirasaki
authors.forename: Ichiei
authors.initials: I
authors.lastname: Narita
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nishi
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Ueno
authors.forename: Takako
authors.initials: T
authors.lastname: Saeki
authors.forename: Shoji
authors.initials: S
authors.lastname: Miyamura
authors.forename: Fumitake
authors.initials: F
authors.lastname: Gejyo
mesh_terms: D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D006978:Hypertension, Renovascular / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D009400:Nephrosclerosis / Q000473:pathology; D009404:Nephrotic Syndrome / Q000209:etiology*; D012078:Renal Artery Obstruction / Q000473:pathology