Salvage from hemodialysis via percutaneous transluminal renal artery stenting for a jeopardized solitary functioning kidney: A case report


      Atherosclerotic renal artery stenosis (ARAS) causes resistant hypertension, progressively declining renal function, and cardiac destabilization syndromes, including heart failure. We report a patient who underwent successful percutaneous transluminal renal angioplasty (PTRA) for anuretic acute kidney injury (AKI) due to ARAS. This patient, admitted to our hospital with congestive heart failure, developed anuretic AKI and started hemodialysis 3 days after admission. Computed tomography and magnetic resonance angiograms showed total occlusion of the proximal right renal artery, with atrophy of the right kidney and severe stenosis of the proximal left renal artery. These findings suggested that only the left kidney was functioning. We performed PTRA of the left renal artery in which the culprit lesion causing the AKI appeared to be located. Using intravascular ultrasound, severe calcification in the ostium of the left renal artery and a necrotic core with plaque rupture in the culprit lesion were observed. Kidney function recovered immediately after revascularization, which permitted successful withdrawal of hemodialysis. There is no clear consensus regarding the indication for PTRA in patients with ARAS; however, our experience suggests that PTRA may be beneficial for patients with a jeopardized solitary functioning kidney.
      <Learning objective: There is no clear consensus regarding the indication for percutaneous transluminal renal angioplasty (PTRA) in patients with atherosclerotic renal artery stenosis. However, patients with a jeopardized solitary functioning kidney may benefit from PTRA, which should be considered as soon as possible before irreversible ischemic changes occur. It is important to recognize that PTRA may be indicated in select similar cases.>


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        • Prince M.
        • Tafur J.D.
        • White C.J.
        When and how should we revascularize patients with atherosclerotic renal artery stenosis?.
        JACC Cardiovasc Interv. 2019; 12 (505-17)
        • Bax L.
        • Woittiez A.J.
        • Kouwenberg H.J.
        • Mali W.P.
        • Buskens E.
        • Beek F.J.A.
        • Braam B.
        • Huysmans F.T.M.
        • Kool L.J.S.
        • Rutten M.J.C.M.
        • Doorenbos C.J.
        • Aarts J.C.N.M.
        • Rabelink T.J.
        • Plouin P.-.F.
        • Raynaud A.
        Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial.
        Ann Intern Med. 2009; 150 (840-8)
        • Wheatley K.
        • Ives N.
        • Gray R.
        • Kalra P.A.
        • Moss J.G.
        • Baigent C.
        • Carr S.
        • Chalmers N.
        • Eadington D.
        • Hamilton G.
        • Lipkin G.
        • Nicholson A.
        • Scoble J.
        • STRAL Investigators
        Revascularization versus medical therapy for renal-artery stenosis.
        N Engl J Med. 2009; 361 (1953–62)
        • Cooper C.J.
        • Murphy T.P.
        • Cutlip D.E.
        • Jamerson K.
        • Henrich W.
        • Reid D.M.
        • Cohen D.J.
        • Matsumoto A.H.
        • Steffes M.
        • Jaff M.R.
        • Prince M.R.
        • Lewis E.F.
        • Tuttle K.R.
        • Shapiro J.I.
        • Rundback J.H.
        Stenting and medical therapy for atherosclerotic renal-artery stenosis.
        N Engl J Med. 2014; 370: 13-22
        • Umemura S.
        • Arima H.
        • Arima S.
        • Asayama K.
        • Dohi Y.
        • Hirooka Y.
        • Horio T.
        • Hoshide S.
        • Ikeda S.
        • Ishimitsu T.
        • Ito M.
        • Ito S.
        • Iwashima Y.
        • Kai H.
        • Kamide K.
        The Japanese society of hypertension guidelines for the management of hypertension (JSH 2019).
        Hypertens Res. 2019; 42 (1235-481)
        • Iwashima Y.
        • Ishimitsu T.
        How should we define appropriate patients for percutaneous transluminal renal angioplasty treatment?.
        Hypertens Res. 2020; 43 (1015–27)
        • Ma Z.
        • Liu L.
        • Zhang B.
        • Chen W.
        • Yang J.
        • Li H.
        Renal artery stent in solitary functioning kidneys: 77% of benefit: a systematic review with meta-analysis.
        Med (Baltimore). 2016; 95 (e4780)
        • Kataoka T.
        • Mathew V.
        • Rubinshtein R.
        • Rihal C.S.
        • Lennon R.
        • Lerman L.O.
        • Lerman A.
        Association of plaque composition and vessel remodeling in atherosclerotic renal artery stenosis: a comparison with coronary artery disease.
        JACC Cardiovasc Imaging. 2009; 2 (327–38)
        • Endo M.
        • Hibi K.
        • Shimizu T.
        • Komura N.
        • Kusama I.
        • Otsuka F.
        • Mitsuhashi M.
        • Iwahashi N.
        • Okuda J.
        • Tsukahara K.
        • Kosuge M.
        • Ebina T.
        • Umemura S.
        • Kimura K.
        Impact of ultrasound attenuation and plaque rupture as detected by intravascular ultrasound on the incidence of no-reflow phenomenon after percutaneous coronary intervention in ST-segment elevation myocardial infarction.
        JACC Cardiovasc Interv. 2010; 3 (540–9)
        • Muray S.
        • Martín M.
        • Amoedo M.L.
        • García C.
        • Jornet A.R.
        • Vera M.
        • Oliveras A.
        • Gómez X.
        • Craver L.
        • Real M.I.
        • García L.
        • Botey A.
        • Montanyà X.
        • Fernández E.
        Rapid decline in renal function reflects reversibility and predicts the outcome after angioplasty in renal artery stenosis.
        Am J Kidney Dis. 2002; 39 (60–6)