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La hipertensión renovascular (HRV) es la forma de hipertensión secundaria más frecuente con una prevalencia que oscila entre el 5-15% (1). Está provocada por una estenosis de la arteria renal, o de sus ramas, que provoca una hipoperfusión renal con la consiguiente activación del sistema renina-angiotensina y posterior aparición de la hipertensión (2). La enfermedad ateroesclerótica es la causa más común de HRV y las lesiones suelen presentarse en los primeros centímetros de la arteria renal pudiendo comprender una gran extensión. La enfermedad fibromuscular es la causa más común de HRV en mujeres jóvenes y el diagnóstico debe ser considerado en alguien con establecimiento temprano, hipertensión severa, aunque ocasionalmente es un hallazgo. Es importante reconocerla, ya que responde bien al tratamiento quirúrgico. Estas lesiones a menudo surgen más allá de los primeros centímetros de la arteria renal y pueden estar asociadas con enfermedad de las ramas más distales.
To the editor: Renovascular hypertension (RVH) is the most common form of secondary hypertension, with a prevalence ranging from 5%-15%.1 RVH is caused by stenosis of the renal artery of its branches that induces renal hypoperfusion leading to activation of the renin-angiotensin system and subsequent occurrence of hypertension.2 Atherosclerotic disease is the most common cause of RVH, and lesions usually occur in the first few centimeters of the renal artery and may involve a large area. Fibromuscular disease is the most common cause of RVH in young women, and diagnosis should be considered in people with early onset of severe hypertension, though it is sometimes and incidental finding. It is important that RVH is recognized, because it responds well to surgical treatment. These lesions often arise beyond the first few centimeters of the renal artery and may be associated to disease in more distal branches.
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To the editor: Renovascular hypertension (RVH) is the most common form of secondary hypertension, with a prevalence ranging from 5%-15%.1 RVH is caused by stenosis of the renal artery of its branches that induces renal hypoperfusion leading to activation of the renin-angiotensin system and subsequent occurrence of hypertension.2 Atherosclerotic disease is the most common cause of RVH, and lesions usually occur in the first few centimeters of the renal artery and may involve a large area. Fibromuscular disease is the most common cause of RVH in young women, and diagnosis should be considered in people with early onset of severe hypertension, though it is sometimes and incidental finding. It is important that RVH is recognized, because it responds well to surgical treatment. These lesions often arise beyond the first few centimeters of the renal artery and may be associated to disease in more distal branches.
We report the case of a 22-year-old female patient who attended the department of nephrology for arterial hypertension. She had no remarkable personal or family history. Physical examination revealed a sitting blood
pressure of 175/100 mmHg and a heart rate of 76 beats per minute. Examination was otherwise unremarkable. Supplemental tests, including complete blood count, biochemistry, urinary catecholamines, urine sediment, chest Xrays, and electrocardiogram, were normal. Treatment was started with bisoprolol, and an angio-MRI was requested for renal study. At 3 months of treatment, the patient showed a slight improvement in her blood pressure values (160/90 mmHg), and angio-MRI revealed doubtful fibrodysplasia at left renal artery level. Renal arteriography was therefore performed for confirmation. Arteriography showed critical stenosis in the right renal segmental artery with collateral circulation and no significant lesions in left renal artery. Angioplasty was performed on this stenosis using a 4 x 20 mm balloon catheter with good morphological result and disappearance of collateral circulation (fig. 1). At 2 years of follow-up, the patient has normal blood pressure values under no drug treatment.
Fibromuscular dysplasia usually occurs in young women aged 15-50 years, and the arterial sector usually affected are the distal 2/3 of the renal artery. RVH caused by involvement of renal artery branches is rare, and in the reported cases the polar arteries3 or the accessory arteries4 were affected. In our case, RVH was caused by involvement of a main branch of the right renal artery. RVH resulting from involvement of this segmental artery is an exceptional case. As regards treatment, advances in endovascular procedures in recent years have allowed for a high success rate in therapeutic management of these patients.
We report the case of a 22-year-old female patient who attended the department of nephrology for arterial hypertension. She had no remarkable personal or family history. Physical examination revealed a sitting blood
pressure of 175/100 mmHg and a heart rate of 76 beats per minute. Examination was otherwise unremarkable. Supplemental tests, including complete blood count, biochemistry, urinary catecholamines, urine sediment, chest Xrays, and electrocardiogram, were normal. Treatment was started with bisoprolol, and an angio-MRI was requested for renal study. At 3 months of treatment, the patient showed a slight improvement in her blood pressure values (160/90 mmHg), and angio-MRI revealed doubtful fibrodysplasia at left renal artery level. Renal arteriography was therefore performed for confirmation. Arteriography showed critical stenosis in the right renal segmental artery with collateral circulation and no significant lesions in left renal artery. Angioplasty was performed on this stenosis using a 4 x 20 mm balloon catheter with good morphological result and disappearance of collateral circulation (fig. 1). At 2 years of follow-up, the patient has normal blood pressure values under no drug treatment.
Fibromuscular dysplasia usually occurs in young women aged 15-50 years, and the arterial sector usually affected are the distal 2/3 of the renal artery. RVH caused by involvement of renal artery branches is rare, and in the reported cases the polar arteries3 or the accessory arteries4 were affected. In our case, RVH was caused by involvement of a main branch of the right renal artery. RVH resulting from involvement of this segmental artery is an exceptional case. As regards treatment, advances in endovascular procedures in recent years have allowed for a high success rate in therapeutic management of these patients.
Bibliography
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J.Menard J.P. Grunfeld. Hipertension Renovascular Tomo I 1982:189-202.
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Strandness DE: Natural history of renal artey stenosis. Am JKidney Dis 24: 630-635, 1994.
[3]
García-Gómez MC, Fernández-Fresnedo G, Sanz de Castro S, Arias M: Hipertensión arterial renovascular secundaria a estenosis de la arteria polar. Nefrología Vol XXII, n 1: 85-86, 2002
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Cuxart M, Picazo M, Matas M, Canalias J, Nadal C, Falcó J: Hipertensión arterial y estenosis de la arteria renal accesoria. Nefrología Vol XXVII n 4: 509-510, 2007
