[Malignant hypertension in a single kidney with doubled blood vessel supply]

A 72-year-old male in acute renal failure, intubated and ventilated, was transferred to our hospital. He had a 30-years history of severe hypertension and signs of general atherosclerosis. 25 years ago, the left kidney had been removed because of an ischaemic renal infarction due to a renal artery stenosis. Blood pressure-monitoring showed excessive high systolic (up to 250 mmHg) and diastolic (up to 160 mmHg) blood pressure.

The MRI-scan revealed a single right kidney with a main artery and an accessory one, both with a severe ostial stenosis. The resistance index (RI) value, measured by duplex ultrasonography was 44.

In two interventional procedures both stenosed arteries were dilated a stent was applied. Afterwards blood pressure and renal function improved.

Severe hypertension can be caused by a renal artery stenosis. It can be diagnosed by duplex ultrasonographic studies, which has the advantage of determining the RI and therefore identifying patients with no improvement of blood pressure or renal function after resolving the stenosis. The angioplasty with or without a stent is as successful as an operation but has less complications.