
Periodicidad semestral: flujo continuo.
ISSN - Electrónico: 2661-6947 / DOI: 10.36015 • LILACS BIREME (19784); LATINDEX (20666)
Case presentation: we report the case of a 63 year-old male with unilateral severe renal artery stenosis diagnosis, renal vascular hypertension, with clinical treatment failure and evidence of initial renal failure, who underwent angioplasty and Stent implantation in the third proximal of the renal right artery, without complications and adequate distal fow. Blood pressure control improved immediately after procedure and one year after adequate control is achieved with two medications and serum values for renal function are normal. Renal artery stenosis is the leading cause of secondary hypertension, and it is related with high rates of adverse cardiovascular consequences; which is why its suspicion and identifcation is important. Several imaging techniques are used to confrm the diagnosis; Doppler ultrasound, angio CT and selective angiography are the most used. Conclusions: current evidence shows that clinical management is the most adequate therapy in these cases, however there is much criticism about recent trials design. A larger, unbiased trial is needed in order to reach a general consensus worldwide.
REFERENCIAS BIBLIOGRÁFICAS
Fagard R. Resistant hypertension. Heart, 2012; 98:254-261
Jaff M. Hypertension and renal artery stenosis: a complex clinical scenario. JAOA, 2000; 100(10):5-9
National Institute for Health and Clinical Excellence. Clinical management of primary hypertension in adults. NHS Evidence, 2011;1:1-34
Kallistratos M, Giannakopuolos A, German V, Manolis A.
Diagnostic modalities in the most common forms of secondary hypertension. Hellenic J. Cardiol, 2010; 51:518-529
Tagle R, Acevedo M. Las preguntas que el clínico debe hacerse en un paciente hipertenso al sospechar una Hipertensión Secundaria. Rev Chil Cardiol, 2009; 28:214-221
Galvañ G y Giner E. Estrategias para el despistaje de la HTA secundaria. Hipertensión Madr, 2006; 23(9):284-297
Chiong J, Aronow W, Khan I, Nair C, Vijayaraghavan K, Dart R y cols. Secondary hypertension: Current diagnosis and treatment. Int J Cardiol, 2008; 124:6-21
Safian R, Textor S. Renal artery stenosis. N Engl J Med, 2001; 344(6):431-442
Radermacher J, Haller H. The right diagnostic work up: investigating renal and renovascular disorders. J Hypertens, 2003; 21(2):19-24
Dworkin L, Cooper C. Renal Artery Stenosis. N Engl J Med, 2009; 361:1972-1978
Kuroda S, Nishida N, Uzu T, Takeji M, Nishimura M y cols.
Prevalence of Renal Artery Stenosis in Autopsy Patients With Stroke. Stroke, 2000; 31:61-65
Rimoldi S, Scherrer U, Messerli F. Secondary Arterial Hypertension: When, Who, and How to Screen? Eur Heart J, 2013; 10:1093-1096
Taler S. Secondary causes of hypertension. Prim Care Clin Office Pract, 2008; 35:489-500
JA K. Secondary hypertension. S Afr Fam Pract, 2011; 53(5):441-442
Riehl J, Schmitt H, Bongartz D, Bergmann D and Sieberth H. Renal artery stenosis: evaluation with colour duplex ultrasonography. Nephrol Dial Transplant, 1997; 12:1608–1614
Vashist A, Heller E, Brown E, Alhaddad I. Renal artery stenosis: A cardiovascular perspective. Am Heart J, 2002; 143:559-564
Colyer W, Eltahawy E, Cooper C. Renal Artery Stenosis: Optimizing Diagnosis and Treatment. Prog Cardiovasc Dis, 2011; 54:29-35
Franc P, Plouin O, Rossignol P, Bobrie G. Atherosclerotic Renal Artery Stenosis: To Treat Conservatively, to Dilate, to Stent, or to Operate? J Am Soc Nephrol, 2001; 12:2190–2196
Martin L, Rundback J, Wallace M, Cardella J, Angle J y cols.
Quality Improvement Guidelines for Angiography, Angioplasty, and Stent Placement for the Diagnosis and Treatment of Renal Artery Stenosis in Adults. J Vasc Interv Radiol, 2010; 21:421–430
Kobo O, Hammoud M, Makhoul N, Omary H. Screening, Diagnosis, and Treatment of Renal Artery Stenosis by Percutaneous Transluminal Renal Angioplasty with Stenting. IMAJ, 2010; 12:140–143
Wheatley K, Ives N, Gray R. Philip A, Moss J. Revascularization versus Medical Therapy for Renal Artery Stenosis. N Engl J Med, 2009; 361:1953-1962
Cooper C, Murphy T, Cutlip D, Jamerson K, Henrich W, et. al.
Stenting and Medical Therapy for Atherosclerotic Renal Artery Stenosis. N Engl J Med, 2014; 370:13-22
Sarac T. Influence and Critique of the ASTRAL and CORAL Trials. Semin Vasc Surg, 2011; 24:162-166
Weinberg M, Olin J. Stenting for atherosclerotic renal artery stenosis: One poorly designed trial after another. Clev Clin J Med, 2010; 77(3):14
The authors who publish in this journal accept the following conditions:
1. The authors retain the copyright and grant to the CAMbios MEDICAL-SCIENTIFIC JOURNAL HECAM the right of the first publication, with the work registered with the Creative Commons attribution license, which allows third parties to use the published material provided that they mention the authorship of the work and the first publication in this journal.
2. Authors can make other independent and additional contractual agreements for the non-exclusive distribution of the version of the article published in this journal (for example, include it in an institutional repository or publish it in a book) as long as it clearly indicates that the work was published. for the first time in the CAMbios MEDICAL-SCIENTIFIC JOURNAL HECAM.