Renin dependent hypertension caused by accessory renal arteries
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Background: Hypokalemia in the presence of hypertension is often attributed to primary hyperaldosteronism as a cause of secondary hypertension, however secondary hyperaldosteronism may present similarly. Accessory renal arteries are variants in the vascular anatomy which are often thought to be innocuous but in some circumstances can cause renovascular hypertension leading to secondary hyperaldosteronism. Case presentation: We report 2 cases of hypertension with secondary hyperaldosteronism associated with accessory renal arteries. Both patients presented with hypokalemia and further investigations revealed hyperaldosteronism with unsuppressed renin levels. Imaging studies showed the presence of accessory renal artery. Conclusion: Accessory renal arteries are a potential cause renovascular hypertension which can be detected via CT angiography or magnetic resonance angiography. Hormonal evaluation should be undertaken to determine whether its presence contributes to hypertension in the patient as targeted treatment such as aldosterone antagonist can be initiated. Surgical intervention or renal denervation may be considered in resistant cases.
Abstract
Background: Hypokalemia in the presence of hypertension is often attributed to primary hyperaldosteronism as a cause of secondary hypertension, however secondary hyperaldosteronism may present similarly. Accessory renal arteries are variants in the vascular anatomy which are often thought to be innocuous but in some circumstances can cause renovascular hypertension leading to secondary hyperaldosteronism. Case presentation: We report 2 cases of hypertension with secondary hyperaldosteronism associated with accessory renal arteries. Both patients presented with hypokalemia and further investigations revealed hyperaldosteronism with unsuppressed renin levels. Imaging studies showed the presence of accessory renal artery. Conclusion: Accessory renal arteries are a potential cause renovascular hypertension which can be detected via CT angiography or magnetic resonance angiography. Hormonal evaluation should be undertaken to determine whether its presence contributes to hypertension in the patient as targeted treatment such as aldosterone antagonist can be initiated. Surgical intervention or renal denervation may be considered in resistant cases.
참고문헌 (21)
- Rimoldi SF, "Secondary arterial hypertension: when, who, and how to screen?", Eur Heart J, 35(19), pp.1245~1254 (2013)
- Ozkan U, "Renal artery origins and variations : angiographic evaluation of 855 consecutive patients", Diagn Interv Radiol, 12, pp.183~186 (2006)
- Marshall AG, "Aberrant renal arteries and hypertension", Lancet, 258(6686), pp.701~705 (1951)
- Kuczera P, "Frequency of renal artery stenosis and variants of renal vascularization in hypertensive patients : analysis of 1550 angiographies in one Centre", J Hum Hypertens, 23(6), pp.396~401 (2009)
- Glodny B, "A possible explanation for the frequent concomitance of arterial hypertension and multiple renal arteries", Med Hypotheses, 56, pp.129~133 (2001)
- Györi E, "Arteriosclerotic stenoses in renal arteries, especially in duplication of arteries; relation to hypertension", Beitr Path Anat, 112, pp.187~204 (1952)
- Glodny B, "Hypertension associated with multiple renal arteries may be renin-dependent", J Hypertens, 18(10), pp.1437~1444 (2000)
- Gupta A, "Accessory renal arteries are not related to hypertension risk : a review of MR angiography data", AJR Am J Roentgenol, 182, pp.1521~1524 (2004)
- Davies ER, "Hypertension and multiple renal arteries", Lancet, 1(7381), pp.341~344 (1965)
- Halpern EJ, "US, CT, and MR evaluation of accessory renal arteries and proximal renal arterial branches", Acad Radiol, 6, pp.299~304 (1999)
- Katial R, "Segmental branch renal artery stenosis diagnosed with captopril renography", J Nucl Med, 33, pp.266~268 (1992)
- Ergun EL, "Tc-99m-DTPA captopril renography in the detection of renovascular hypertension due to renal polar artery stenosis", Ann Nucl Med, 15, pp.167~170 (2001)
- Morton KA, "Diagnostic use of angiotensin converting enzyme(ACE)-inhibited renal scintigraphy in the identification of selective renal artery stenosis in the presence of multiple renal arteries : a case report", J Nucl Med, 31(11), pp.1847~1850 (1990)
- Pratap T, "Potential pitfalls of renal angiography : a case of atypical Fibromuscular dysplasia", Angiology, 59(6), pp.753~756 (2008)
- Kem DC, "Renin-dependent hypertension caused by non focal stenotic aberrant renal arteries : proof of a new syndrome", Hypertension, 46, pp.380~385 (2005)
- Id D, "Does the presence of accessory renal arteries affect the efficacy of renal denervation?", JACC Cardiovasc Interv, 6, pp.1085~1091 (2013)
- Bohm M, "First report of the global SYMPLICITY registry on the effect of renal artery denervation in patients with uncontrolled hypertension", Hypertension, 65(4), pp.766~774 (2015)
- VonAchen P, "Accessory renal arteries : prevalence in resistant hypertension and an important role in nonresponse to radiofrequency renal denervation", Cardiovasc Revasc Med, 17(7), pp.470~473 (2016)
- Mendelsohn FO, "Does complete renal denervation translate into superior clinical outcomes? Lessons learned from denervation of accessory renal arteries", Clin Res Cardiol, 103(9), pp.681~683 (2014)
- Atas H, "Successful accessory renal artery denervation in a patient with resistant hypertension", Heart Views, 15(1), pp.19~21 (2014)
- Ozmen CA, "An unusual reason for Renovascular hypertension : entrapment of an accessory renal artery by the diaphragmatic crus", J Vasc Interv Radiol, 10, pp.1713~1714 (2006)