Esayag-Tendler B, Yamase H, Ramsby G, White W B
Department of Medicine, University of Connecticut School of Medicine, Farmington.
Am J Kidney Dis. 1994 Jun;23(6):869-73. doi: 10.1016/s0272-6386(12)80143-0.
Typical causes of renovascular hypertension include intramural atherosclerotic lesions of the main renal arteries or their branches and fibromuscular dysplasia of the renal arterial wall with luminal narrowing. We report a patient with new-onset, accelerated hypertension (blood pressure 220/140 mm Hg, status epilepticus, retinal hemorrhages) secondary to a dissection of the anterior division of the right renal artery that was accompanied by hyperreninemia, hyperaldosteronism, and hypokalemia. At presentation in the untreated state, unstimulated plasma renin activity and the serum aldosterone level were markedly elevated. Following right nephrectomy, blood pressure levels normalized without antihypertensive therapy, and plasma renin activity, serum aldosterone and potassium levels normalized. Histologic study of the right renal artery showed an isolated dissection of the anterior branch of the vessel between the muscularis and adventitia that created marked reduction in luminal diameter and renal ischemia. There was no evidence of any other vascular abnormalities, atherosclerosis, or fibromuscular dysplasia. These findings demonstrate that an isolated dissection of a branch of the renal artery may induce profound hyperreninemia and represents a rare, reversible etiology for accelerated hypertension associated with acute encephalopathy.
肾血管性高血压的典型病因包括主要肾动脉或其分支的壁内动脉粥样硬化病变以及肾动脉壁纤维肌发育异常伴管腔狭窄。我们报告了一名新发的急进性高血压患者（血压220/140 mmHg，癫痫持续状态，视网膜出血），其病因是右肾动脉前支夹层，伴有高肾素血症、醛固酮增多症和低钾血症。在未治疗状态下就诊时，基础血浆肾素活性和血清醛固酮水平显著升高。右肾切除术后，血压水平在未进行抗高血压治疗的情况下恢复正常，血浆肾素活性、血清醛固酮和钾水平也恢复正常。右肾动脉的组织学研究显示，在肌层和外膜之间的血管前支出现孤立性夹层，导致管腔直径显著减小和肾缺血。没有证据表明存在任何其他血管异常、动脉粥样硬化或纤维肌发育异常。这些发现表明，肾动脉分支的孤立性夹层可能诱发严重的高肾素血症，并且是与急性脑病相关的急进性高血压的一种罕见的、可逆病因。
