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4 0 0 0 OA Treatment of Refractory Hypertension with Timely Angioplasty in Total Renal Artery Occlusion with Atrophic Kidney

著者
Yuri Sasaki Eikan Mishima Koichi Kikuchi Takafumi Toyohara Takehiro Suzuki Hideki Ota Kazumasa Seiji Mariko Miyazaki Hideo Harigae Sadayoshi Ito Kei Takase Takaaki Abe
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
pp.5290-20, (Released:2020-08-22)
参考文献数
27
被引用文献数
3
Angioplasty for cases of chronic total occlusion of renal artery with/without atrophic kidney is generally not recommended. We here report a 57-year-old man who presented with renin-mediated refractory hypertension caused by occlusion of a unilateral renal artery leading to kidney atrophy (length: 69 mm). Angioplasty favorably achieved blood pressure control with normalized renin secretion and enlargement of the atrophic kidney to 85 mm. Timely angioplasty can be beneficial in select patients, even with an atrophic kidney and total occlusion, especially in cases with deterioration of hypertension within six months and the presence of collateral perfusion to the affected kidney.

2 0 0 0 OA Apparent Diffusion Coefficient in the Resolution of Renal Ischemia after Angioplasty on Diffusion-weighted Imaging: A Case of Renal Artery Stenosis Caused by Progressive Thrombosis in Residual Chronic Aortic Dissection

著者
Eikan Mishima Hideki Ota Takehiro Suzuki Takafumi Toyohara Kazumasa Seiji Sadayoshi Ito Yoshikatsu Saiki Kei Takase Takaaki Abe
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
pp.3855-19, (Released:2020-01-17)
参考文献数
21
We report a case in which diffusion-weighted magnetic resonance imaging (DWI) demonstrated renal artery stenosis-related renal ischemia and the therapeutic efficacy of revascularization. The patient was a 73-year-old man, who underwent descending thoracic aortic replacement due to DeBakey IIIb chronic aortic dissection, and who showed progressive renal dysfunction due to right renal artery stenosis caused by false lumen thrombosis. DWI demonstrated a decreased apparent diffusion coefficient (ADC) in the right kidney, indicating renal ischemia. Angioplasty with stenting restored renal perfusion and improved the renal function, resulting in the normalization of the decreased ADC in the treated kidney. Thus, DWI can be used to monitor renal ischemia in cases involving advanced renal artery stenosis.