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Kidney Week

Abstract: TH-PO458

Repeat Intravascular Ultrasound Guided Renal Artery Angioplasty in a Patient with Fibromuscular Dysplasia

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Author

  • Chenna, Avantika, Southwest georgia nephrology----, Albany, Georgia, United States
Introduction

Fibromuscular dysplasia (FMD) is one of the etiologies of renal artery stenosis (RAS) and secondary hypertension. Balloon angioplasty has emerged is emerging as a mainsstay of treatment in patients with FMD usually show substantial clinical response to renal angioplasty without stenting.

Case Description

We report a case of 32 -year-old male case of secondary hypertension from RAS due to with repeat intravascular ultrasound guided renal artery angioplasty. Her blood pressure ( BP) was 165/95 with heart rate of 89 bts/min on presentation with chronic headaches.Her physcial exam was within normal limits. Labs revealed sodium of 138, potassium of 4.6, chloride of 97 and bicarbonate of 23 mmol/l respectively. BUN was 13 and creatinine was 0.87 mg/dl respectively. Secondary hypertension workup was negative except borderline elevated renin level. Doppler renal ultrasound showed increased velocity in the proximal portion of left renal artery concerning for left RAS. Patient's medications were adjusted including maximum dose of lisinopril without improvement in home blood pressure readings. Renal angiography was performed which revealed classic beaded appearance of bilateral renal artery showing FMD. Therefore, percutaneous transluminal angioplasty of bilateral renal arteries was performed.BP improved temporarily for a month after the procedure but slowly started to go up with average BP being 150's systolic and 100's diastolic. Doppler renal ultrasound showed increased velocities in bilateral renal arteries. Therefore percutaneous transluminal angioplasty of bilateral renal arteries was performed again.BP improved after the second balloon angioplasty and was now sustained. 3 months after follow up her BP improved to systolic 110-120 and diastolic of 70-80 mm hg without requiring any antihypertensives.

Discussion

This is the only case reported in medical literature to the best of our knowledge where repeat balloon angioplasty was attempted with successful and sustained BP control. Through this case we propose that repeat intravascular ultrasound guided renal artery angioplasty can be considered in patients with bilateral RAS due to FMD in whom the first attempt fails to control BP without stent placement. Further studies are needed to study the long term benefits of this procedure on BP control and kidney function.