Somalanka Subash, Harris Fiona E, Chemla Eric, Suckling Rebecca Jo, Swift Pauline A
Department of Nephrology, South West Thames Renal & Transplantation Unit, St Helier Hospital, Carshalton, UK.
Department of Vascular Surgery, St George's Healthcare NHS Trust, London, UK.
BMJ Case Rep. 2017 Aug 16;2017:bcr-2017-220438. doi: 10.1136/bcr-2017-220438.
Renal Artery Stenosis (RAS) is an important cause of treatment-resistant hypertension. Uncontrolled hypertension with RAS can cause progressive chronic kidney disease (CKD) leading to end-stage kidney disease. Therapeutic revascularisation can be helpful in appropriate circumstances where pharmaceutical intervention has failed and significant renovascular disease contributes to resistant hypertension. We present an interesting case of a Caucasian male with peripheral vasculopathy, abdominal aortic aneurysm (AAA), single functioning kidney and ostial RAS caused by stent struts from an endovascular AAA stent graft. He had escalating medications requirement, with repeated failed attempts at percutaneous radiological intervention that led to an episode of contrast-induced acute kidney injury (AKI), before undergoing successful surgical revascularisation by a splenic artery transposition graft to the left renal artery that was performed to improve kidney function and the blood pressure. This report highlights the challenges faced with regard to the management of severe hypertension and progressive CKD.
肾动脉狭窄（RAS）是难治性高血压的一个重要原因。伴有RAS的未控制高血压可导致进行性慢性肾脏病（CKD），进而发展为终末期肾病。在药物干预失败且严重肾血管疾病导致难治性高血压的适当情况下，治疗性血管重建可能会有所帮助。我们呈现了一个有趣的病例，一名患有周围血管病变、腹主动脉瘤（AAA）、单功能肾以及由血管内AAA支架移植物的支架支柱导致的肾动脉开口处RAS的白种男性。他对药物的需求不断增加，经皮放射介入治疗多次失败，导致了一次造影剂诱发的急性肾损伤（AKI），随后通过脾动脉转位移植至左肾动脉成功进行了手术血管重建，以改善肾功能和血压。本报告强调了在严重高血压和进行性CKD管理方面所面临的挑战。
