Renovascular Hypertension: 12 Cases

Introduction Renovascular hypertension (RVH) is a secondary form of hypertension haracterized by renal hypo perfusion. Stenosis of the main renal artery or its branches is the most common type of renovascular disease that can produce renovascular hypertension. Renovascular hypertension is not common. Methods It's a retrospective study conducted in our department, during 18 years from January1990 to December 2008. Results Our study concerned 12 patients; the mean age was about 38 years. RVH was suspected in several situations. In fact six patients were aged less than 30 years, in eight patients hypertension appeared recently, it was severe in six cases, and resistant to medical treatment in eight cases. Three patients presented an abdominal breath. Hypokaliemia were found in five cases. Renal ultrasound objective renal atrophy in eight patients. Diagnosis was confirmed by Doppler ultrasound in eight patients. Plasma renin activity was useful for the diagnosis of RVH in three patients. Renal scintigraphy was used in eleven patients. Renal angiographic techniques were performed in eight cases, stenosis were unilateral in four cases and bilateral in four cases. RVH was per-operatory discovered in one case. RVH was secondary to fibromuscular dysplasia in two cases, to Takayasu's vasculitis in three cases, to an extrinsic compression by retroperitoneal fibrosis in one case, to atherosclerosis in two cases. Three of our patients were treated by percutaneous renal artery intervention for renal stenosis. Nephrectomy was indicated in seven cases. Conclusion Renovascular hypertension is a potentially curable form of secondary hypertension. Angiography remains the ‘gold standard’ for diagnosing renal artery stenosis; however, it is expensive, invasive. Non-invasive screening measures are being sought such as unenhanced and enhanced duplex ultrasound. One further area of investigation is whether Doppler-derived velocity data can be used to calculate pressure gradients across a stenosis, and evaluate what constitutes a significant pressure gradient.