Atherosclerotic Renovascular Disease

Area of Science:

• Nephrology
• Cardiology
• Vascular Surgery

Background:

• Elderly patients with hypertension and renal insufficiency require thorough investigation.
• Acute kidney injury can be a presenting symptom of underlying vascular disease.

Purpose of the Study:

• To present a case of severe hypertension and acute kidney injury caused by bilateral renal artery stenosis.
• To emphasize the importance of early diagnosis and management of renal artery stenosis.

Main Methods:

• Clinical presentation and physical examination findings.
• Laboratory tests including complete blood count, electrolytes, cardiac enzymes, blood urea nitrogen, serum creatinine, and urinalysis.
• Diagnostic imaging including chest X-ray, electrocardiogram, renal sonography, and renal angiogram.

Main Results:

• The patient presented with severe hypertension (240/118 mm Hg), acute kidney injury (serum creatinine 3.6 mg/dl rising to 10.7 mg/dl), and symptoms of heart failure and claudication.
• Renal angiogram revealed 90% occlusion of the right renal artery and 70% occlusion of the left renal artery, with significant atherosclerotic disease.
• Hemodialysis and subsequent spontaneous improvement in renal function were observed, with serum creatinine returning to 3.4 mg/dl.

Conclusions:

• Bilateral renal artery stenosis can lead to severe, life-threatening hypertension and acute kidney injury.
• Renal angiography is essential for diagnosing renal artery stenosis in patients with unexplained hypertension and deteriorating renal function.
• Management may involve medical therapy, revascularization, or dialysis, with potential for renal function recovery.