Abstract: FR-PO853
Renal Artery Stenosis in Early High-Risk Pregnancy
Session Information
- Women's Health and Kidney Diseases
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Llamas, Marielle, Samaritan Health Services, Corvallis, Oregon, United States
- Andrea, Tyler, Samaritan Health Services, Corvallis, Oregon, United States
Introduction
Renovascular hypertension is an uncommon cause of hypertension in pregnancy.1 Renovascular hypertension management is complicated by contraindication in pregnancy to established first line treatment of ACE-I and ARBs due to teratogenicity. The potential teratogenic risks of radiological intervention using fluoroscopy limits diagnostic options.2 Previous cases of pregnant patients presenting with new onset or superimposed preeclampsia secondary to renovascular hypertension have been rarely reported.2 We present a case report of renovascular hypertension in a pregnant patient who was at 17 weeks gestation at the time of diagnosis.
Case Description
38-year-old pregnant female presenting for routine prenatal care. Preexisting diagnoses of insulin-dependent T2DM complicated by diabetic neuropathy, combined systolic/diastolic heart failure, history of methamphetamine use in remission, prior stroke x2 with residual left-sided deficits (2020), and poorly controlled hypertension.
Confirmatory 24 -hour urine protein: 7,410 mg/24H
24h BP monitor: average reading of 185/87
Aldosterone/renin activity ratio: normal
Regularly scheduled visits with her obstetrician soon revealed difficulties with hypertension control, resulting in an increase of her labetalol dose to 300 mg twice daily. At 17 weeks gestation, duplex ultrasound of the renal arteries confirmed high-grade stenosis at the origin of high renal artery, greater than 70%. Patient was promptly admitted for renal revascularization with renal artery stenting.
Discussion
Diagnosis of RAS can be done through duplex ultrasound imaging, CTA scan, or MRA. A catheter angiogram, which requires contrast to be injected via a catheter threaded through the renal artery is considered the gold standard diagnostic tool. However, it is not widely used during pregnancy due to radiation effects.7 While extra-abdominal radiologic examinations render insignificant exposures to the pregnant uterus, high quality tools such as, fluoroscopically- or CT-guided interventional procedures (such as renal artery angioplasty) should be carefully considered during pregnancy.8
The management of hypertension in early pregnancy should involve screening for RAS, especially in the setting of resistance to antihypertensive medications. 7 The benefits of early diagnosis of renal artery stenosis in pregnancy must be balanced with the risks of diagnostic imaging, interventional procedures, and its teratogenic risks.