In hypertensive patients it is very important to detect renal artery stenosis or pheochromocytoma, since both diseases are curable causes of hypertension. However, renal artery stenosis can be induced by pheochromocytoma, when the diagnosis of the two simultaneous disease is very difficult. We experienced two cases of pheochromocytoma presented as renal artery stenosis. Pheochromcytoma was overlooked when renovascular hypertension was diagnosed. Pheochromocytoma was found during surgery in one patient and after angioplasty in the other. In both cases, BP returned to normal after surgical removal of pheochromocytoma without repair of the stenosis. Prevention of ineffective and unnecessary renal artery angioplasty of surgery requires knowledge of this unusal association between pheochromocytoma and renal artery stenosis and a high degree of clinical alertness for pheochromocytoma.
Angioplasty ; Constriction, Pathologic ; Diagnosis ; Humans ; Hypertension ; Hypertension, Renovascular ; Pheochromocytoma* ; Renal Artery Obstruction* ; Renal Artery*

Renal artery thrombosis can cause acute occlusion of unilateral or bilateral renal arteries,and kidney failure would be induced if it is not diagnosed and treated in time.Therefore,rapid and correct treatment is especially important for renal artery thrombosis.Due to the lack of specificity of clinical manifestations,this disease in commonly misdiagnosed or missed and thus has a low early diagnosis rate.Here we report a case of acute renal artery thrombosis to improve the diagnosis and treatment.
Acute Disease ; Diagnostic Errors/adverse effects* ; Humans ; Renal Artery ; Renal Artery Obstruction/diagnosis* ; Thrombosis/etiology*

Aged ; Coronary Disease ; complications ; Humans ; Hypertension ; complications ; Renal Artery Obstruction ; diagnosis ; Renal Insufficiency ; complications ; Risk Factors

Acute thrombotic renal artery occlusion is rarely identified at premortem. Early diagnosis and treatment are crucial for salvage of renal function. We reported a case of successfully dissolved acute thrombotic occlusion of renal artery of 9 hour duration with intra-arterial infusion of urokinase in a 83-year-old man.
Aged, 80 and over ; Early Diagnosis ; Humans ; Infusions, Intra-Arterial ; Renal Artery Obstruction ; Renal Artery* ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator*

Renovascular hypertension secondary to renal artery vascular disease is the most common form of surgically correctable hypertension. The common causes of renovascular hypertension are atherosclerosis, fibromuscular dysplasia, and Takayasu arteritis. Takayasu arteritis is a chronic nonspecific arteritis of unkown cause that is relatively prevalant in young female subjects. It has been well known that the pathologic feature of the disease consist predominantly of occulsive changes in the aorta and the origin of its major branches. The most important pathogenetic mechanism of hypertension seems to be through renal artery stenosis. We have experimented three hypertensive patients with Takayasu arteritis experienced. Basic diagnosis was established by angiographic study. This article presents surgical treatment methods of Takayasu arteritis with renovascular hypertension and brief review of literatures.
Aorta ; Arteritis ; Atherosclerosis ; Diagnosis ; Female ; Fibromuscular Dysplasia ; Humans ; Hypertension ; Hypertension, Renovascular ; Renal Artery ; Renal Artery Obstruction ; Takayasu Arteritis ; Vascular Diseases

Ischemic nephropathy is defined as renal dysfunction due to renal hypoperfusion mainly through renal artery stenosis. It is a common cause of chronic renal failure in old patients with atherosclerosis and is also a potentially correctable cause of renal failure if diagnosed earlier. We experienced a case of sudden Rt. main renal artery occlusion and renal failure after femoral artery angioplasty in an aged male patient with underlying atherosclerotic bilateral renovascular stenosis associated with ischemic nephropathy. He received successful Lt. renal artery angioplasty with stenting and restored Lt. renal artery blood flow. His blood pressure was more easily controlled with fewer antihypertensive drugs after renal artery revascularization. His renal function was recovered to his baseline level and became stabilized thereafter. Early diagnosis of ischemic nephropathy with MRA and timely renal angioplasty with stenting are beneficial to avoiding progression to irreversible renal failure.
Angioplasty* ; Antihypertensive Agents ; Atherosclerosis ; Blood Pressure ; Constriction, Pathologic ; Early Diagnosis ; Femoral Artery ; Humans ; Kidney Failure, Chronic ; Male ; Renal Artery Obstruction* ; Renal Artery* ; Renal Insufficiency* ; Stents*

BACKGROUNDBalanced steady-state free precession MR angiography (b-SSFP MRA) has shown great promise in diagnosing renal artery stenosis (RAS) as a non-contrast MR angiography (NC-MRA) method. However, results from related studies are inconsistent. The purpose of this meta-analysis was to assess the accuracy of b-SSFP MRA compared to contrast-enhanced MR angiography (CE-MRA) in diagnosing RAS.

METHODSEnglish and Chinese studies that were published prior to September 4, 2013 and that assessed b-SSFP MRA diagnostic performance in RAS patients were reviewed. Quality of the literature was assessed independently by two observers. The statistical analysis was adopted by the software of Meta-Disc version 1.4. Using the heterogeneity test, a statistical effect model was chosen to calculate different pooled weighted values. The receiver operator characteristic (ROC) space and Spearman correlation coefficient were to explore threshold effect. Sensitivity analysis and the publication bias were performed to demonstrate if the pooled estimates were stable and reliable. We produced forest plots to calculate the pooled values and corresponding 95% confidence interval (CI) of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and constructed a summary receiver operating characteristic curve (SROC) to calculate the area under the curve (AUC).

RESULTSA total of 10 high quality articles were used in this meta-analysis. The studies showed a high degree of heterogeneity. The "shoulder-arm" shape in the ROC plot and the Spearman correlation coefficient between the log(SEN) and log(1-SPE) suggested that there was a threshold effect. Sensitivity analysis demonstrated that the actual combined effect size was equal to the theoretical combined effect size. The publication bias was low after quality evaluation of the literature and the construction of a funnel plot. The pooled sensitivity was 0.88 (95% CI, 0.83-0.91) and pooled specificity was 0.94 (95% CI, 0.93-0.95); pooled PLR was 14.57 (95% CI, 9.78-21.71]) and pooled NLR was 0.15 (95% CI, 0.11-0.20). The AUC was 0.964 3.

CONCLUSIONIn contrast to CE-MRA, the b-SSFP MRA is more accurate in diagnosing RAS, and may be able to replace other diagnostic methods in patients with renal insufficiency.

The most common type of refractory hypertension found in children is secondary hypertension, which is a potentially curable disease. Reninoma, a renin-secreting juxtaglomerular cell tumor, is a rare cause of severe hypertension that is usually diagnosed in adolescents and young adults. Surgical resection of the tumor completely cures the hypertension of patients with reninoma. The typical clinical presentation of reninoma includes hypokalemia, metabolic alkalosis, and features secondary to the increased activation of the renin-angiotensin system without renal artery stenosis. We report a case of reninoma in a female adolescent with a typical clinical presentation, in which surgical removal of the tumor completely cured hypertension. We discuss here the clinical features, imaging studies, and immunohistochemical examination of the tumor used to establish the diagnosis of reninoma and for the management of the condition.
Adolescent ; Alkalosis ; Child ; Diagnosis ; Humans ; Hypertension ; Hypertension, Renal ; Hypokalemia ; Juxtaglomerular Apparatus ; Renal Artery Obstruction ; Renin ; Renin-Angiotensin System ; Young Adult

Renal infarction usually occurs in patients with atrial fibrillation, valvular heart disease, trauma, renal artery stenosis, atherosclerosis and coagulopathy. However it may occur rarely in patients without such underlying disease. We report on 3 patients who developed renal infarction and had no underlying disease. In two cases, renal artery thrombosis occured. And in the other case, renal artery dissection occured. All patients of the renal infarction experienced severe flank pain. And increased serum LDH, ALT and ALP was noted. The differential diagnosis of renal artery dissection and renal artery thrombosis was established by renal artery angiography. In two patients with renal artery thrombosis, anticoagulation therapy was performed. In the other patient with renal artery dissection, only conservative therapy was performed. All 3 patients of renal infarction preserved normal renal function. but developed hypertension. Two patients were given anti-hypertensive agents. In the other patient, hypertension was normalized spontaneously.
Adult* ; Angiography ; Antihypertensive Agents ; Atherosclerosis ; Atrial Fibrillation ; Diagnosis, Differential ; Flank Pain ; Heart Valve Diseases ; Humans ; Hypertension ; Infarction* ; Renal Artery ; Renal Artery Obstruction ; Thrombosis

PURPOSE: We compared captopril renal scintigraphic criteria for the diagnosis of renovascular hypertension by unilateral renal artery stenosis. MATERIALS AND METHODS: The study group consisted of 24 patients (m/f =16/8, age: 39 +/- 18 years) with unilateral renal artery stenosis who underwent renal artery revascularization and captopril renal scintigraphy with 99mTc-diethylenetriaminepentaacetic acid between May 1995 and April 2004. The blood pressure response was classified as cure/improvement or failure. We evaluated captopril-induced changes in relative function (BCfun) and renogram grade (0 to 5: 0=normal, and 5=renal failure pattern without measurable uptake) (CBren) and the difference of renograms between the normal and stenotic kidney on captopril scan (CNren). RESULTS: Eight of 24 patients were cured and 11 improved and 5 patients were classified as failed revascularization. Significant predictors of a cure or improvement of blood pressure were younger age, stenosis by fibromuscular dysplasia or arteritis, BCfun, CBren and CNren. Areas under the receiver operating characteristic curve of age, BCfun, CBren and CNren were not significantly different. Positive and negative predictive values of predictors were 100% and 42% (age < or= 38) ; 92% and 50% (BCfun > or= 1%) ; 92% and 75% (CBren > or= 1), and 90% and 60% (CNren > or= 1), respectively. CONCLUSION: Captopril induced changes in renal function and renogram can reliably predict hypertension response to revascularization. Renogram pattern on captopril scan can diagnose renovascular hypertension without baseline data in patients with unilateral renal artery stenosis.
Arteritis ; Blood Pressure ; Captopril* ; Constriction, Pathologic ; Diagnosis* ; Fibromuscular Dysplasia ; Humans ; Hypertension ; Hypertension, Renovascular* ; Kidney ; Radionuclide Imaging ; Renal Artery Obstruction* ; Renal Artery* ; ROC Curve