[Acute renal failure and hypertension].

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Interventional Radiology

Background:

• Ischemic nephropathy, often linked to hypertension, presents diagnostic and therapeutic challenges.
• Renal artery stenosis is a significant cause of secondary hypertension and ischemic nephropathy.
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists (ARBs) are commonly used for hypertension but can precipitate acute kidney injury in renal artery stenosis.

Observation:

• A patient with bilateral renal artery stenosis and hypertension experienced acute worsening of chronic renal failure after initiating valsartan, an ARB.
• The patient's deteriorating renal function necessitated dialysis, indicating severe kidney compromise.
• This case highlights a potential adverse effect of ARBs in patients with bilateral renal artery stenosis.

Findings:

• Percutaneous transluminal renal artery angioplasty and stenting were performed to address the bilateral renal artery stenosis.
• Treatment was complemented by aggressive hydration and discontinuation of valsartan.
• These interventions led to a rapid and sustained recovery of renal function, avoiding the need for long-term dialysis.

Implications:

• This case underscores the critical importance of recognizing the risk of ARB-induced kidney injury in patients with renal artery stenosis.
• Renal artery angioplasty and stenting represent an effective treatment strategy for selected patients with ischemic nephropathy and severe renal artery stenosis.
• A multidisciplinary approach, including medication management and interventional procedures, is crucial for optimizing outcomes in complex renal artery stenosis cases.