title: Attending rounds: a patient with accelerated hypertension and an atrophic kidney.
abstract: This case represents an individual with accelerating hypertension and declining kidney function associated with atherosclerotic renal artery stenosis. Key features include loss of GFR (reaching stage V CKD) during intensified antihypertensive drug therapy including agents that block the renin-angiotensin system and failure to appreciate the extent to which moderate renal artery stenosis was affecting his better kidney. Interpretation of duplex ultrasound studies was complicated by a discrepancy between near-normal peak systolic velocities and markedly abnormal segmental arterial waveforms. It was essential to recognize that both kidneys were abnormal and focus on recovery of perfusion to the better of these kidneys. Successful revascularization of one kidney allowed major improvement in GFR and BP control.
authors.affiliation: Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota textor.stephen@mayo.edu.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Textor
mesh_terms: D000368:Aged; D000577:Amides / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D050197:Atherosclerosis / Q000150:complications*; D001284:Atrophy / Q000209:etiology; D001794:Blood Pressure; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005650:Fumarates / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology*; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008297:Male; D011412:Propanolamines / Q000627:therapeutic use; D012078:Renal Artery Obstruction / Q000150:complications* / Q000628:therapy; D015607:Stents; D056164:Teaching Rounds
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D002227:Carbazoles; D005650:Fumarates; D011412:Propanolamines; D000077261:Carvedilol; C446481:aliskiren