Renal Angioplasty – Case Study
Case 01 : Young girl (18 yrs) with Blood pressure of 220/120 mm Hg
A young college going student presented with severe headaches and blurring of vision. Examination revealed very high blood pressure. Kidney function was normal. Renal artery Doppler demonstrated severe stenosis of the mid-segment of the right renal artery. Balloon angioplasty was performed to this narrowing, with excellent results, and immediate normalization of the blood pressure. In young patients, Fibromuscular dysplasia is the most common cause of renal artery narrowing. Since this is an inflammatory condition, stenting is usually not indicated in this type of disease. Long term results are quite encouraging.
Case 02 : Elderly Man With Hypertension and Abnormal Renal function
A 70 year old man presented with progressive rise in blood pressure and an elevated serum creatine level of 2.2 mg %. Multiple anti hypertensive drugs failed to control the high blood pressure. Renal artery Doppler study confirmed presence of critical stenosis of lower left renal artery. Angioplasty and stenting of this artery was performed. The blood pressure was now brought under control, and renal function also improved. In elderly patients, the commonest cause of stenosis is atherosclerosis. Usually there may be associated calcification. It is therefore essential to implant a stent in these cases, to prevent restenosis.
Case 03 : Stenting of Main Renal Artery
This 75 year old woman presented with severe headache of one months duration. She was found to have severe recent onset hypertension. Doppler ultrasound suggested renal artery stenosis, which was confirmed by angiography. She underwent balloon dilatation and placement of stent in the renal artery, with immediate relief of the high blood pressure.
Case 04 : Angioplasty in Only Surviving Kidney
This 85 year old lady presented to a Nephrologist with a diagnosis of severe hypertension and renal failure, with a serum creatinine level of 6 mg%. Investigations by ultrasound Doppler revealed a occluded right renal artery and a severe 95% Stenosis of the right renal artery. The lady underwent successful angioplasty and stenting of the only surviving left renal artery. Within a week, the blood pressure was normalized without the need for any antihypertensive medications, and within one month the serum creatinine was normalized to 1.3 mg %.