Renal artery stenosis

Case contributed by Brendan Cullinane

Presentation

Long-term hypertension, which had been medically controlled until a recent sharp increase in blood pressure.

Patient Data

Age: 65 years
Gender: Male
Ultrasound
  • Aorta at the level of the SMA.
  • The lumen of the origin, proximal and mid RRA appears narrowed with some aliasing under colour Doppler ultrasound.
  • The lumen of the distal RRA appears normal and no aliasing is seen.
  • Velocity at the RRA origin is markedly increased. There is a 5-fold increase over the velocity within the aorta. 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 OK - 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-aorta-ratio up to 5 and apparent luminal narrowing and aliasing from the origin to mid-point of the right renal artery. Greater than 0.5 difference in the resistive indices of the intrarenal waveforms between both kidneys. These findings suggest a >70% stenosis in the right renal artery despite tardus-parvus waveforms not being seen.

Case Discussion

There is a 5-fold increase of renal artery velocity over aortic velocity. These findings suggest a >70% stenosis.

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Case information

rID: 14760
Published: 27th Aug 2011
Last edited: 27th Apr 2018
Inclusion in quiz mode: Included

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