[Renal artery stenosis after abdominal radiotherapy]

Area of Science:

• Nephrology
• Cardiology
• Oncology

Background:

• Renal artery stenosis (RAS) is a significant cause of secondary hypertension.
• While fibrodysplasia and atherosclerosis are common causes, radiation-induced RAS is rare.
• This condition can manifest years after radiation therapy for abdominal cancers.

Observation:

• A 49-year-old male presented with severe hypertension (230/125 mmHg) seven years post-abdominal radiotherapy for Hodgkin's disease.
• Echo-Doppler and renal angiography revealed subocclusive ostial stenosis of the right renal artery, presumed to be radiation-induced.
• Percutaneous transluminal renal artery angioplasty achieved a successful outcome with residual stenosis <50%.

Findings:

• Radiation-induced RAS is uncommon, affecting 0.5 to 1 per 1000 individuals.
• The median latency period from radiation exposure to RAS diagnosis is approximately nine years.
• Atherosclerosis accelerated by radiation damage to larger vessels is a proposed mechanism.

Implications:

• This case highlights that radiation-induced RAS can occur long after initial treatment.
• Patients with severe hypertension following abdominal radiation require investigation for RAS.
• Percutaneous intervention offers a successful treatment modality for radiation-induced RAS.