Renal artery stenosis in a solitary functioning kidney - case report

We report a case of severe hypertension caused by renal artery stenosis of congenital solitary kidney in a 24-year-old female. After an admission of our 24-year female patient to hospital, the initial investigation ruled out endocrine cause of arterial hypertension. The left kidney could not be visualized by the ultrasound examination of the abdomen, so we did the CT scan of the abdomen using per oral and intravenous contrast and the diagnosis of left kidney agenesis followed by the compensatory enlargement of the right kidney was established. While some cases of renovascular stenosis may be diagnosed by Doppler ultrasound, other cases have demonstrated that this technique may miss the diagnosis of renovasular hypertension. Renal angiography revealed a stenotic area in the upper renal artery of a solitary functioning kidney. It was 1.5 cm wide; the degree of the stenosis was over 60%. Renal artery supplying the inferior part of the kidney was without any pathological changes. Although renal arteriography is the golden standard in diagnosing renal artery stenosis, there are certain risks: procedure-related complications and contrast induced nephropathy. Endovascular treatment is an alternative to surgery with lower morbidity rates. Stenting the stenotic renal artery in solitary functioning kidney either improves or stabilizes the renal function and provides stabilization of the blood pressure. Implantation of stent in upper renal artery of the solitary functioning kidney in our patient led to normalization of hypertension and improvement of renal functioning.