| Sub-title | |
| Authors | C Chetcuti Ganado V Grech |
| Abstract | Renal artery stenosis (RAS) commonly occurs in later life due to atherosclerosis. Fibromuscular RAS (FMD) is rarer, and tends to occur in young adults, particularly women aged 20 to 40 years. We present a 13 year old boy with bilateral RAS at the renal artery origins due to FMD, who presented initially with Bells palsy due to undetected hypertension. Two years later, he represented with severe hemiplegia due to hypertensive haemorrhagic stroke. Diagnosis was made with isotope studies and with angiography. Balloon treatment failed and renal revascularisation was achieved with a bifurcated homograft from descending aorta to both renal arteries distal to the stenoses. Hypertension was controlled but recurred after four years and was associated with left flank pain. Repeat angiography showed thrombotic obstruction of the left limb of the homograft despite antiplatelet medication. The homograft was reopened with thrombolytic infusion by catheter directly into the homograft. Renovascular hypertension is the most common cause of secondary hypertension, and the commonest cause of renovascular hypertension is RAS. RAS is also increasingly recognised as an important cause of chronic renal insufficiency and end stage renal disease. Unilateral renal artery stenosis causes ischaemic nephropathy on the affected side and uncontrolled hypertension leads to hypertensive nephrosclerosis on the nonaffected side, therefore both uni- and bilateral renal artery stenosis may lead to progressive renal failure. |
Published in: | |
| Journal | Malta Medical Journal |
| Volume | Volume 15 (suppl) |
| Pages | - |
| Date | |
| Link to journal | |
| Key words | bilateral renal artery stenosis, bells palsy, hemiplegia, paediatrics |