Question

During a routine medical checkup, Candace, a 26-year old physiotherapy student, is surprised to hear that her blood pressure is 180/110. She also has a rumbling systolic and diastolic abdominal bruit (murmur) that is loudest at the mid-epigastric area. Her physician suspects renal artery stenosis (narrowing). She orders an abdominal ultrasound and renal artery arteriography, which confirms that Candace has a small right kidney, and that the distal part of her right renal artery is narrowed by more than 70%. Her physician prescribes diuretics and calcium channel blockers as temporary measures, and refers Candace to a cardiovascular surgeon. Explain the connection between Candace's renal artery stenosis and her hypertension. Why is her right kidney smaller than her left? What would you expect Candace's blood levels of K+,\mathrm{K}^{+}, Na+,\mathrm{Na}^{+}, aldosterone, angiotensin II, and renin to be?

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Renal Artery Stenosis

  • is a well known cause of 2ry Hypertension.
  • and also a cause of Renal Failure.

Etiology :

1- Atherosclerosis of renal artery. 2- Fibromuscular dysplasia. 3- Rare causes include: Takayasu arteritis, Dissecting aneurysm, External artery compression by tumor or fibrosis.

clinical picture :

1- Hypertension : usually severe, of recent onset and difficult to control. 2- Bruit : an abdominal or flank bruit ( = systolic and diastolic abdominal Bruit, loudest at the mid- epigastric area ). 3- may be Hypokalemia and mild Metabolic Alkalosis. 4- Kidney Size : - kidneys are asymmetrical in size. - there is reduction in kidney size ( in affected side ) in long standing stenosis which can be detected by abdominal Ultrasound. 5- Renal impairment.

Investigations :

1- Abdominal Ultrasound : a discrepancy in size between the 2 kidneys. 2- Renal Isotope Scanning. 3- Renal Vein Renin studies. 4- Renal Angiography.

Treatment:

1- Medical Treatment : Antihypertensive drugs e,g, diuretics and calcium channel blockers. 2- Angioplasty " PTCA ". 3- Surgical resection of affected segment and reanastomosis.

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