11/777. Bilateral renal infarction secondary to paradoxical embolism. Paradoxical embolism is an uncommon but increasingly reported cause of arterial embolic events. Involvement of the kidney is rarely reported. autopsy studies suggest, however, that embolic renal infarction is underdiagnosed antemortem. We report a case of bilateral, main renal artery occlusion and acute renal failure secondary to paradoxical embolism. Clinical and laboratory data at presentation were not suggestive of renal infarction. Support for the diagnosis of paradoxical embolism, which most commonly occurs across a patent foramen ovale, was made by contrast echocardiography, which provides a sensitive method for detecting right-to-left intracardiac shunts. The often subtle presentation of renal infarction suggests patients with peripheral or central arterial embolic events should be carefully observed for occult renal involvement. Contrast echocardiography should be performed when renal infarction occurs without a clear embolic source to evaluate for paradoxical embolism. ( info) |
12/777. Detection of renovascular hypertension: saralasin test versus renin determinations. Angiotensin blockade was established in hypertensive patients with the competitive inhibitor saralasin and the blood pressure response was compared to prior renin determinations. Two patients with subsequently confirmed renovascular hypertension had normal peripheral renin and non-lateralizing renal vein renin ratios, yet both showed a clear-cut lowering of blood pressure after administration of the blocking agent, indicating the presence of renin-mediated hypertension. Thus, direct in vivo testing with saralasin appears to offer certain advantages over renin determinations. ( info) |
| A patient with rheumatic heart disease developed right renal artery embolism and was treated by renal artery embolectomy. After a brief historical data, etiologic factors, clinicopathologic points, and treatment of the disease have been discussed. ( info) |
14/777. Percutaneous transluminal angioplasty of renal artery stenosis in a child with hypertensive heart disease. A 1.5-year-old girl developed congestive heart failure 9 months after she presented with hypertension. The hypertension was caused by a renal artery stenosis. A short-segment stenosis at the ostium of the left renal artery was confirmed by arteriogram. After balloon angioplasty, the blood pressure and heart function returned to normal. angioplasty had an excellent result of relieving hypertension and heart failure in this patient. Cathet. Cardiovasc. Intervent. 48:374-377, 1999. ( info) |
| Two patients with acute renal artery embolism were reported. One patient had a history of rheumatic valvular heart disease and the other patient had hereditary cardiomyopathy. Both patients had atrial fibrillation on physical examination. Both patients presented with acute back pain and one patient had hematuria. The final diagnosis of acute renal artery embolism was made after one to three days of hospitalization and renal angiography was finally done documenting complete occlusion of the main branch of the renal artery on one side. Intra-arterial streptokinase infusion 5,000 unit per hour was given to both patients using an arterial pump for 17 hours to 30 hours with complete recanalization of the intrarenal branches and complete recovery of signs and symptoms of renal artery embolism although the renal scan still showed diminished renal function. ( info) |
16/777. Acute renal artery occlusion. Eeven cases of acute renal artery occlusion are reviewed. The clinical presentation and features of the condition are discussed and reasons for delays in diagnosis are examined. Two cases in whom active treatment was carried out are described in detail. Acute renal artery occlusion is most common in patients with severe cardiac disease and this may influence decisions on treatment. ( info) |
17/777. renal artery stenosis associated with epidermal nevus syndrome. Epidermal nevus syndrome is an unusual neurocutaneous disorder in which epidermal nevi are associated with abnormalities of the skeleton and central nervous system, including the eyes and somtimes the cardiovascular system. We treated a patient in whom the latter included renal artery stenosis. An 18-year-old man with epidermal nevi was diagnosed as having the syndrome based on the additional presence of scoliosis, an arachnoid cyst in the middle cranial fossa, and microphthalmos. hypertension was diagnosed when the patient was 15 years old. The plasma renin activity (9.7 ng/ml/h) was elevated. Right renal artery stenosis was demonstrated by angiography, and the abdominal aorta was narrowed distal to the ostium of the superior mesenteric artery. The plasma renin activity in the right renal vein (16 ng/ml/h) was higher than contralaterally (10 ng/ml/h). Several cardiovascular manifestations have been reported as a complication of epidermal nevus syndrome. hypertension in an individual with epidermal nevi and congenital anomalies should prompt a search for a vascular anomaly. ( info) |
| prognosis in Takayasu's arteritis is limited owing to renovascular hypertension. The authors report a patient with Takayasu's arteritis who had been unilaterally nephrectomized and presented with malignant hypertension due to renal artery stenosis. hypertension was refractory to conventional antihypertensive treatment, and stenosis was not accessible by interventional angioplasty. Initiation of enalapril and losartan therapy was successful in improving blood pressure without deterioration of renal function due to ischemic failure. Antihypertensive treatment resulted in dramatically stimulated endogenous nitric oxide (NO) synthesis, while elevated plasma endothelin-1 levels were unchanged. Renovascular hypertension in Takayasu's arteritis is associated with an imbalance of vasoconstrictor peptide endothelin-1 and vasodilator peptide NO. Successful treatment of hypertension by enalapril or losartan results in improved endogenous NO synthesis, which putatively counterbalances excessive vasoconstrictor actions and may retard the progression of renal failure. ( info) |
| Renal graft thrombosis is a rare but devastating complication of renal transplantation. It accounts for one-third to one-half of early graft losses. We report a patient with acute renal artery and vein thrombosis associated with abnormally short activated partial thromboplastin time (aPTT) and factor v Leiden mutation. Vascular thrombosis developed on the ninth post-transplant day and led to a graft loss. Before transplantation, the patient had three episodes of thrombosis of arteriovenous access for hemodialysis. Our case illustrates the importance of investigating pretransplant patients for hypercoagulable states, particularly those with short aPTT. ( info) |
| We describe a 26-year-old white female with a history of Raynaud phenomenon, erythema nodosum, polyarthralgias, migraine, vertigo, seizures, transient ischemic attacks, one fetal loss, and false positive VDRL, who developed milk hypertension without overt lupus nephritis. She had positive antinuclear antibodies (ANA) and double-stranded deoxyribonucleic acid (dsDNA) antibodies. The lupus anticoagulant test (LAC) and cardiolipins antibodies (aCL) were positive. She was diagnosed as having a Systemic Lupus Erythematosus-like illness (SLE-like) with 'secondary' antiphospholipid syndrome (APS). Renal spiral computed tomography (CT) with intravenous (IV) contrast showed bilateral renal artery stenosis. Anticoagulation with acenocumarol was started. She became normotensive without antihypertensive drugs five months later. A follow-up renal spiral CT showed complete recanalization of both renal arteries, making thrombosis the more likely culprit pathology in the stenosis. After two years follow up the patient is normotensive. She remains on acenocumarol. ( info) |