[Arterial hypertension and rapidly progressing renal failure].

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Interventional Radiology

Background:

• Atherosclerotic renovascular disease (ARVD) can lead to progressive chronic kidney disease and difficult-to-manage hypertension.
• Stable, mild renal insufficiency can rapidly progress to end-stage renal disease (ESRD) in the presence of underlying vascular pathology.
• Accelerated hypertension is a significant complication of ARVD, often exacerbating renal damage.

Observation:

• A case report details a patient with a history of mild renal insufficiency who presented with acute decline in kidney function and severe hypertension.
• Diagnostic work-up revealed significant bilateral renal artery stenoses as the underlying cause.
• The patient experienced a rapid deterioration necessitating intervention.

Findings:

• Percutaneous transluminal renal angioplasty (PTRA) with stenting was performed to address the severe renal artery stenoses.
• The procedure resulted in significant improvement in both renal function and blood pressure control.
• Twelve months post-procedure, the patient remained free from the need for dialysis.

Implications:

• Revascularization via PTRA is an effective treatment for ARVD, improving both renal function and hypertension.
• In patients with ESRD secondary to ARVD, PTRA can potentially postpone the need for renal replacement therapy.
• This case highlights the importance of timely diagnosis and intervention for atherosclerotic renovascular disease to preserve kidney function and manage hypertension.