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Renal transplant hypertension caused by iliac artery stenosis
E V Dubovsky1, A G Diethelm, F Keller
1Division of Nuclear Medicine, University of Alabama, Birmingham Medical Center.
Insights
Captopril renal studies using radiohippuran and 99mTc-MAG3 revealed stenosis in a hypertensive kidney transplant patient. Successful iliac artery angioplasty resolved the hypertension.
Area of Science:
- Nephrology
- Radiology
- Vascular Surgery
Background:
- Hypertension is a common complication in renal allograft recipients.
- Renal artery stenosis (RAS) can cause or exacerbate hypertension in transplant patients.
- Accurate diagnosis of RAS is crucial for effective management.
Purpose of the Study:
- To evaluate the utility of captopril renography with radiohippuran and 99mTc-MAG3 in diagnosing hemodynamically significant stenosis in a hypertensive renal allograft recipient.
- To investigate the source of stenosis causing hypertension in a renal allograft recipient.
- To assess the outcome of angioplasty for identified vascular stenosis.
Main Methods:
- Captopril renography was performed using both radiohippuran and technetium-99m mercaptoacetyltriglycine (99mTc-MAG3).
- Arteriography was utilized to visualize the renal and iliac arteries.
- Successful angioplasty was performed on the identified stenotic lesion.
Main Results:
- Captopril renography showed changes consistent with hemodynamically significant stenosis.
- Arteriography revealed high-grade stenosis in the iliac artery, not the renal artery.
- Following angioplasty, the patient's hypertension resolved completely.
Conclusions:
- Captopril renography can indicate significant stenosis in renal allograft recipients.
- Iliac artery stenosis, rather than renal artery stenosis, can cause or mimic RAS in hypertensive renal allograft recipients.
- Angioplasty is an effective treatment for resolving hypertension caused by iliac artery stenosis in this population.
Abstract:
A captopril renal study performed with both radiohippuran and 99mTc-MAG3 demonstrated the typical changes of a hemodynamically significant renal artery stenosis in a hypertensive renal allograft recipient. Arteriography demonstrated high grade stenosis not of the renal artery but of the iliac artery. After successful angioplasty, the patient's hypertension resolved.