Renal artery stenosis presenting with nephrotic-range proteinuria: a case report

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Interventional Radiology

Background:

• Renal artery stenosis (RAS) typically presents with hypertension and chronic kidney disease.
• Nephrotic-range proteinuria is an unusual manifestation of RAS.
• Accurate diagnosis and timely intervention are crucial for managing RAS complications.

Purpose of the Study:

• To report a rare case of RAS presenting with nephrotic-range proteinuria in an elderly male.
• To illustrate the diagnostic challenges and therapeutic strategies for atypical RAS presentations.
• To highlight the importance of considering RAS in patients with unexplained proteinuria and azotemia.

Main Methods:

• Case report of a 78-year-old male with nephrotic-range proteinuria.
• Diagnostic workup included renal biopsy and computed tomography angiography (CTA).
• Interventions involved angiotensin receptor blocker therapy, renal artery stenting, and stent graft placement.

Main Results:

• Renal biopsy revealed mesangiopathic glomerulonephritis, not directly explaining the proteinuria.
• CTA confirmed significant left-sided RAS, leading to renal artery stenting.
• Post-stenting, aortic dissection occurred, requiring further intervention; subsequent stent graft placement resolved proteinuria and improved renal function.

Conclusions:

• Renal artery stenosis can manifest with unusual symptoms like nephrotic-range proteinuria.
• A multidisciplinary approach is essential for managing complex cases involving RAS and vascular complications.
• Successful intervention for RAS can lead to significant improvement in renal function and proteinuria, even after initial treatment setbacks.