Presentation
Long-term hypertension, which had been medically controlled until a recent sharp increase in blood pressure.
Patient Data
Age: 65 years
Gender: Male
From the case:
Renal artery stenosis
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- aorta at the level of the superior mesenteric artery (SMA)
- the lumen of the origin, proximal and mid-right renal artery (RRA) appears narrowed with some aliasing under color Doppler ultrasound
- the lumen of the distal RRA appears normal and no aliasing is seen
- velocity at the RRA origin is markedly increased and is 5 times greater than the aortic velocity. These findings suggest a >70% stenosis
- velocities within the proximal RRA remain markedly elevated
- velocities within the mid-RRA remain markedly elevated
- velocity in the distal RRA is within normal limits. No tardus-parvus waveforms were seen
- the intrarenal waveforms in the right kidney are normal, with possible loss of the early systolic peak. The resistive indices were >0.5 lower than in the left kidney (see next picture) supporting compromised blood supply to the right kidney
- there is an early systolic peak in the intrarenal waveforms of the left kidney. Resistive indices were >0.5 higher than in the right kidney
Markedly elevated velocities, a renal/aortic ratio of up to 5 and apparent luminal narrowing and aliasing from the origin to the midpoint of the right renal artery. A difference greater than 0.5 in the resistive indices of the intrarenal waveforms between the kidneys.
These findings suggest a >70% stenosis in the right renal artery despite tardus-parvus waveforms not being seen.
Case Discussion
The renal artery velocity is 5 times greater than aortic velocity, suggesting a >70% stenosis.
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