Occluded renal artery and a contralateral moderate renal artery stenosis – Which side should be treated?

Abstract

Renal artery stenosis is the most common secondary cause of hypertension. We present a case of a 22-year-old man with uncontrolled hypertension despite taking four antihypertensive medications including a diuretic agent. Duplex ultrasound showed bilateral renal artery stenosis with total occlusions of the right renal artery and moderate stenosis (60%) of left renal artery. Renogram showed decreased function of both kidneys especially in the right. Renal fractional flow reserve showed no significant hemodynamic disturbance in the left renal artery. Thus, percutaneous transluminal angioplasty with renal stenting was performed in the right renal artery. After one month of follow up, the patient showed no symptoms, good control of blood pressure and improvement of kidney function. Renal scintigraphy and renal fractional flow reserve measurement play an important role for clinical decision making regarding the need for renal revascularization.