Institute of Nephrology, Department of Medicine, D'Annunzio University, Chieti, Italy
Keywords: hypertension; percutaneous transluminal renal angioplasty; recombinant tissue plasminogen activator; renal failure
A 74-year-old woman with recent worsening of long-standing hypertension and mild renal failure was admitted to our Unit in January 2000. On physical examination, the patient had a para-umbilical and a carotid murmur. Blood pressure was 190/105 mmHg. She had a history of intermittent claudication and several transient ischaemic episodes.
Renal ultrasound examination showed a very small left kidney and a right kidney of 10.5 cm with slightly irregular margins. A presumptive diagnosis of atheromatous renal artery disease was made, and magnetic resonance angiography was performed. The proximal portion of the right renal artery showed a severe stenosis, whereas the contralateral artery could not be detected. Renal digital arteriography showed a complete occlusion of the left renal artery and a severe para-ostial atheromatous stenosis of the right artery (Fig. 1).
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Atherosclerotic disease of the renal arteries is an important cause of renal failure in elderly patients [1]. Various mechanisms contribute to renal insufficiency: renal damage due to hypertension [2], atheroembolism of the renal arteries, and a low perfusion pressure beyond the stenosis of the artery [3]. Percutaneous transluminal angioplasty with or without wall stenting is a well-known method of treating ischaemic nephropathy. The aim of revascularization in this type of pathology is the attempt to preserve or improve renal function, to prevent end-stage renal failure, and to make hypertension more responsive to medical therapy. Mid-term follow-up indicates that in about 75% of the cases, the result of PTA with stenting is satisfactory at more than 18 months [4]. The overall complication rate, including artery dissection and acute thrombosis, is considered to be 9% [5].
Our report demonstrates that prompt treatment with r-tPA may be safe and successful.
Notes
Correspondence and offprint requests to: U. Brümmer, Institute of Nephrology, SS Annunziata Hospital, Via dei Vestini, I-66013 Chieti, Italy.
References