[An unusual case of severe arterial hypertension and acute renal failure in an obese young adult].
We report a case of type-B aortic dissection occurring in a 38-year-old obese man, whose past medical history was positive for arterial hypertension and apparently negative for chronic kidney disease. The patient had severe refractory hypertension and acute renal insufficiency due to renal vascular impairment. The correct diagnosis was delayed because the clinical presentation was atypical, initially mimicking an acute abdominal inflammatory process (such as acute pyelonephritis) with secondary sepsis, and there was no major hemodynamic impairment. Percutaneous management (endografting of the thoracic aorta to seal the thoracic intima tear and renal revascularization by PTA+stenting) led to remission, albeit partial, of the acute renal insufficiency and to target blood pressure achievement with use of multiple antihypertensive agents. Follow-up at 12 months showed stable renal function, normal endograft placement and normal aortic diameter at CT examination. The percutaneous endovascular management of aortic dissection is a valid alternative to traditional surgery, with less morbidity and mortality; when the renal circulation is impaired by the aortic dissection, aortic endografting and renal revascularization by PTA+stenting, where appropriate, may allow at least partial reversal of renal insufficiency and target blood pressure achievement.
D'Amico
M
M
U.O. Nefrologia e Dialisi, Ospedale S. Anna, Como, Italy.
Melfa
G
G
Galli
M
M
Llambro
M
M
Giura
C
C
Beltrame
A
A
Demelas
L
L
Grillo
C
C
D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002404:Catheterization; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D009765:Obesity / Q000150:complications*; D011704:Pyelonephritis / Q000175:diagnosis; D015641:Radiography, Interventional; D015607:Stents; D013348:Subclavian Artery; D014057:Tomography, X-Ray Computed
D000959:Antihypertensive Agents