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Abstract: PO2123

A Curious Case of Hypertensive Emergency and AKI

Session Information

Category: Trainee Case Report

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Hu, Dennis, University of Virginia Health System, Charlottesville, Virginia, United States
  • Karimi, Ashkan, Augusta Health, Fishersville, Virginia, United States
  • Campbell, Garland A., University of Virginia Health System, Charlottesville, Virginia, United States
  • Pourafshar, Negiin, University of Virginia Health System, Charlottesville, Virginia, United States
Introduction

We report a case of a 75-year-old female with history of a prior right renal artery stent (coronary bare metal stent), stage IV chronic kidney disease (baseline serum creatinine (Scr) 2.1-2.3 mg/dL (eGFR 20-23 ml/min/1.73 m2)), diastolic heart failure, and hypertension who presented with hypertensive emergency (blood pressure (BP) 220/80 mmHg) and flash pulmonary edema.

Case Description

During her hospital stay, despite treatment with up to nine anti-hypertensive medications, her systolic BP remained 180-200 mmHg. Her Scr also increased to 3.92. Work-up showed normal kidney sizes and urine protein/creatinine ratio 1.26 g/g. Renal artery duplex revealed right renal artery peak systolic velocity 267 cm/sec, renal-to-aortic ratio 2.68, and resistive index 0.7-0.9, suggestive of right renal artery re-stenosis and some intrinsic damage. Due to progressive volume overload and worsening respiratory status, she required temporary hemodialysis. As her volume status improved, she underwent CO2 angiogram and was found to have 90% diffuse in-stent restenosis with marked deformity of the previous stent. She underwent re-stenting of the right renal artery with a proprietary FDA-approved Herculink Elite® renal stent with only 8 ml of contrast. Immediately post-intervention, her BP dramatically improved and after two months, her dialysis was stopped (new baseline SCr 1.5-1.9) and she only requires two BP medications.

Discussion

This case highlights several important points. First, renal ultrasound should be considered in the work-up of patients with hypertensive emergency and history of renal stent due to the risk of re-stenosis. Second, it highlights the importance of using an appropriate FDA approved stent in the renal position as placement of coronary stents in the renal position might have a higher incidence of structural failure and re-stenosis.

Deformed stent (arrow) with severe in-stent restenosis