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BMC Nephrol 2022 Jun 16;23(1):210. Epub 2022 Jun 16.

Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, England.

Background: Atherosclerotic renovascular disease (ARVD) often follows an asymptomatic chronic course which may be undetected for many years. However, there are certain critical acute presentations associated with ARVD and these require a high index of suspicion for underlying high-grade RAS (renal artery stenosis) to improve patient outcomes. These acute presentations, which include decompensated heart failure syndromes, accelerated hypertension, rapidly declining renal function, and acute kidney injury (AKI), are usually associated with bilateral high-grade RAS (> 70% stenosis), or high-grade RAS in a solitary functioning kidney in which case the contralateral kidney is supplied by a vessel demonstrating renal artery occlusion (RAO). Read More

Ann Vasc Surg 2022 Jul 12;83:35-41. Epub 2022 Mar 12.

Loma Linda University Medical Center, Loma Linda, CA.

Background: Renal artery stenosis (RAS) is an uncommon cause of pediatric hypertension. Guidelines for workup and management have not been established. The most widely reported etiology of the pediatric renovascular disease has been fibromuscular dysplasia; however, other etiologies including middle aortic syndrome (MAS) and vasculitides have been described. Read More

Clin Sci (Lond) 2022 02;136(3):239-256

Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, U.S.A.

Renovascular disease (RVD) remains a common etiology of secondary hypertension. Recent clinical trials revealed unsatisfactory therapeutic outcomes of renal revascularization, leading to extensive investigation to unravel key pathophysiological mechanisms underlying irreversible functional loss and structural damage in the chronically ischemic kidney. Research studies identified complex interactions among various players, including inflammation, fibrosis, mitochondrial injury, cellular senescence, and microvascular remodeling. Read More

Semin Pediatr Surg 2021 Dec 30;30(6):151124. Epub 2021 Oct 30.

Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Fegan 3, Boston, MA 02115, USA. Electronic address:

Midaortic syndrome (MAS) is a rare condition characterized by stenosis of the abdominal aorta with or without the involvement of branch vessels. The majority of cases are thought to be idiopathic though MAS has been associated with a number of conditions including granulomatous vasculitis, neurofibromatosis-1 (NF-1), Alagille Syndrome, fibromuscular dysplasia (FMD), and Williams syndrome. Patients typically present with hypertension due to decreased renal perfusion. Read More

BMC Cardiovasc Disord 2021 12 20;21(1):606. Epub 2021 Dec 20.

Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Zhongshan District, Dalian, Liaoning Province, China.

Background: A honeycomb-like structure (HLS) is a rare abnormality characterized by a braid-like appearance. Angiograph and intravascular examination, including coherence tomography and intravascular ultrasound (IVUS), can further confirm the multiple intraluminal channels or honeycomb structure, which can also be described as looking like 'swiss cheese', a 'spider web' or a 'lotus root'. Previous studies have mostly reported this abnormality in coronary arteries, with a few cases in renal arteries. Read More

J Vasc Interv Radiol 2022 04 9;33(4):399-407. Epub 2021 Dec 9.

Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, People's Republic of China. Electronic address:

Purpose: To evaluate the midterm outcomes of percutaneous transluminal renal angioplasty (PTRA) for pediatric renovascular hypertension (RVH).

Materials And Methods: The clinical data of patients who underwent PTRA for RVH in the authors' hospital from 2012 to 2019 were retrospectively analyzed. Postprocedural blood pressure, glomerular filtration rate (GFR) of the affected kidney, restenosis, and complications were closely monitored. Read More

Blood Press 2021 12 26;30(6):416-420. Epub 2021 Oct 26.

Department of Renal Medicine and the Clinic of Hypertension, Aarhus University Hospital, Aarhus, Denmark.

A 16-year-old patient presented with abdominal pain and sustained hypertension. Thorough evaluation including renography with and without captopril and renal vein renin sampling were normal. Duplex ultrasound, however, raised suspicion of a renal artery stenosis. Read More

J Hum Hypertens 2022 Apr 25;36(4):420-422. Epub 2021 Oct 25.

Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.

J Vasc Surg 2022 03 30;75(3):939-949.e1. Epub 2021 Sep 30.

Department of Radiology, La Timone Hospital, Marseille, France.

Objective: The indication of percutaneous renal transluminal angioplasty (PTRA) in fibromuscular dysplasia (FMD) is mainly based on renal artery stenosis (RAS) due to atherosclerosis criteria, which are not specific to FMD. Consequently, the selection of patients who could benefit from this treatment and its effectiveness remain uncertain. The aims of this study were to: (1) report the effects of PTRA guided by trans-stenotic pressure measurements on hypertension 7 months after treatment; (2) assess the impact of pressure measurement to guide treatment efficacy in comparison to visual angiographic parameters; and (3) evaluate the reproducibility and accuracy of the stenosis measurement using a 4F catheter in comparison to a pressure guidewire. Read More

Medicina (Kaunas) 2021 Sep 8;57(9). Epub 2021 Sep 8.

Nephrologic Unit, Department of Translational and Precision Medicine, University of Rome 'La Sapienza', 00185 Rome, Italy.

We report the case of a 65-year-old man with acute GFR decline to 37 mL/min and uncontrolled high blood pressure. He was suspected for renovascular hypertension and underwent a renal color Doppler ultrasound scan that detected a bilateral atherosclerotic renal artery stenosis. A digital selective angiography by percutaneous transluminal angioplasty and stenting (PTRAs) was successfully performed. Read More

J Hypertens 2021 12;39(12):2439-2445

Department of Nephrology, Kidney Transplantation and Hypertension.

Background: Although the clinical presentation of fibromuscular dysplasia (FMD) and its generalized character has been previously described in adults, data on FMD in children are limited.

Method: In this study, we aimed to assess visceral artery involvement in pediatric FMD patients with documented renal artery stenosis (RAS) and renovascular hypertension (RVH) in comparison with healthy individuals. We retrospectively analyzed the results of angiographic studies of 16 patients with a median age of 13. Read More

Ann Vasc Surg 2022 Jan 3;78:379.e1-379.e5. Epub 2021 Sep 3.

Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China. Electronic address:

Background: To describe a retrograde recanalization for the proximal occluded lesion in right renal artery (RRA) in young patient with fibromuscular dysplasia (FMD).

Methods: A 10-year-old girl presented to our hospital with proximal RRA occlusion and refractory hypertension though she took anti-hypertension medicines. Her renin and aldosterone were beyond the normal level in both base state and excited state. Read More

JACC Case Rep 2021 Aug 4;3(9):1211-1215. Epub 2021 Aug 4.

Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.

Hyperperfusion injury is a rare but critical complication associated with revascularization for long-standing severe artery stenosis. Here we report a rare case of a patient with renal hyperperfusion injury after undergoing percutaneous transluminal renal angioplasty for renovascular hypertension as a sequela of neuroblastoma after radiation therapy. (). Read More

BMJ Case Rep 2021 Aug 13;14(8). Epub 2021 Aug 13.

Department of Internal Medicine, Saint Joseph's Hospital Braunau Department of Internal Medicine I, Braunau, Oberösterreich, Austria.

A 34-year-old patient with a short history of severe hypertension was admitted to our hospital. Considering the young age and the severity of hypertension, we investigated the most common causes of secondary hypertension. Exposure to a single dose of an ACE inhibitor resulted in a rapid decline of the renal function. Read More

Pediatr Nephrol 2022 01 8;37(1):49-59. Epub 2021 Jul 8.

Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK.

Renovascular disease is an important secondary cause of hypertension in childhood. In this cohort, many may have undiagnosed cerebrovascular disease, and some children present acutely with cerebrovascular complications. However, these associations are yet to be defined in the literature. Read More

Acta Radiol 2022 Jul 9;63(7):964-975. Epub 2021 Jun 9.

Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Renal arteries are involved in a wide spectrum of pathologies including atherosclerosis, fibromuscular dysplasia, Takayasu arteritis, aneurysms, and aortic type B dissections extending into main renal arteries. They manifest as renovascular hypertension, renal ischemia, and cardiovascular dysfunction. The location of the renal arteries in relation to the abdominal aortic aneurysm is a critical determinant of interventional options and long-term prognosis. Read More

BMJ Case Rep 2021 May 26;14(5). Epub 2021 May 26.

Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.

Renal vascular hypertension is a diagnosis that needs to be entertained in the setting of refractory, otherwise unexplained hypertension in pregnancy. Conclusive diagnosis of the condition is made by the use of angiography, which confers only a low, safe dose of radiation to the fetus, especially after the first trimester. Percutaneous angioplasty is effective in treating this condition and is best performed postnatally to avoid fetal exposure to ionising radiation. Read More

Acta Biomed 2021 04 30;92(S1):e2021162. Epub 2021 Apr 30.

University of Parma.

Background Fibromuscolar dysplasia (FMD) is an idiopathic, non-atherosclerotic and non-inflammatory stenotic lesion of renal arteries causing renovascular hypertension up-regulating renin-angiotensin-aldosterone system. Case report: A 18-year-old man was referred to our Hypertension Center (Clinica e Terapia Medica) for the recent onset of hypertension, poorly controlled on calcium channel blockers, already associated to electrocardiographic and echocardiography signs of left ventricular hypertrophy and significant albuminuria (728 mg/24 h). An increased plasma renin activity (PRA), aldosterone level and a mild hypokalemia raised the suspicion of renovascular hypertension. Read More

Can J Cardiol 2021 10 20;37(10):1671-1673. Epub 2021 Apr 20.

Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. Electronic address:

We present a case of severe renal artery stenosis that mimicked rapidly progressive glomerulonephritis with acute kidney injury, active urine sediments, and severe hypertension. Simultaneous presence of secondary hyperaldosteronism and hypokalemia prompted renal angiography and subsequent renal artery angioplasty and stenting, leading to rapid resolution of acute kidney injury, proteinuria, and hypertension. This case emphasises the importance and benefits of prompt diagnosis and revascularisation of acute severe renal artery stenosis in a patient with history of atherosclerotic renovascular disease presenting with sudden onset of severe hypertension and acute kidney injury with active urine sediment mimicking rapidly progressive glomerulonephritis. Read More

Pediatr Nephrol 2021 12 13;36(12):3853-3868. Epub 2021 Apr 13.

Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.

Renovascular hypertension (RVH) is defined as an elevated blood pressure caused by kidney hypoperfusion, generally as a result of anatomic stenosis of the renal artery with consequent activation of the Renin Angiotensin-Aldosterone System. The main causes include genetic and inflammatory disorders, extrinsic compression, and idiopathic alterations. RVH is often asymptomatic and should be suspected in any child with refractory hypertension, especially if other suggestive findings are present, including those with severe hypertension, abdominal bruit, and abrupt fall of glomerular filtration rate after administration of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. Read More

CEN Case Rep 2021 11 7;10(4):506-509. Epub 2021 Apr 7.

Department of Nephrology, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.

Moyamoya disease (MMD) has long been known to be associated with hypertension. While renal artery stenosis (RAS) is considered one of the causes of hypertension with MMD, most hypertension causes remain unexplained. A boy with MMD was diagnosed with renovascular hypertension (RVH) due to left-sided RAS by angiography. Read More

Life (Basel) 2021 Mar 7;11(3). Epub 2021 Mar 7.

Department of Clinical Pharmacology, Wroclaw Medical University, Wroclaw, Poland.

Renal artery stenosis (RAS) is conditioned mainly by two disturbances: fibromuscular dysplasia or atherosclerosis of the renal artery. RAS is an example of renovascular disease, with complex pathophysiology and consequences. There are multiple pathophysiological mechanisms triggered in response to significant renal artery stenosis, including disturbances within endothelin, kinin-kallikrein and sympathetic nervous systems, with angiotensin II and the renin-angiotensin-aldosterone system (RAAS) playing a central and key role in the pathogenesis of RAS. Read More

Hypertension 2021 04 10;77(4):1022-1028. Epub 2021 Mar 10.

Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville (A.K., G.C., R.M.).

Invest Radiol 2021 02;56(2):86-93

From the Division of Nephrology and Hypertension.

Materials And Methods: Stenotic kidney (STK) and contralateral kidney magnetization transfer ratios (MTRs; Mt/M0) were measured at 3.0-T magnetic resonance imaging, at offset frequencies of 600 and 1000 Hz, before and 1 month post-PTRA in 7 RVD pigs. Stenotic kidney MTR was correlated to renal perfusion, renal blood flow (RBF), and glomerular filtration rate (GFR), determined using multidetector computed tomography and with ex vivo renal fibrosis (trichrome staining). Read More

Hypertension 2021 02 4;77(2):507-518. Epub 2021 Jan 4.

From the Division of Nephrology and Hypertension (X.-J.C., S.R.K., K.J., C.M.F., H.T., X.-Y.Z., A.E., L.O.L.), Mayo Clinic, Rochester, MN.

Scattered tubular-like cells (STCs), dedifferentiated renal tubular epithelial cells, contribute to renal self-healing, but severe injury might blunt their effectiveness. We hypothesized that ischemic renovascular disease (RVD) induces senescence in STC and impairs their reparative potency. CD24+/CD133+ STCs were isolated from swine kidneys after 16 weeks of RVD or healthy controls. Read More

J Vasc Surg 2021 07 16;74(1):79-89.e2. Epub 2020 Dec 16.

Department of Surgery, Boston Children's Hospital, Boston, Mass. Electronic address:

Objective: To evaluate the outcomes of various surgical approaches in the treatment of renovascular hypertension and midaortic syndrome (MAS) in children.

Methods: We performed a retrospective medical record review of patients who had undergone surgery for renovascular hypertension from 2010 to 2018 at our center under the care of a multidisciplinary team. The operative interventions included mesenteric artery growth improves circulation (MAGIC), tissue expander-stimulated lengthening of arteries (TESLA), aortic bypass using polytetrafluorethylene, renal artery reimplantation, and autotransplantation. Read More

Ann Vasc Surg 2021 Feb 4;71:536.e5-536.e8. Epub 2020 Nov 4.

Department of Vascular surgery, Rouen University Hospital, Rouen, France.

We present an uncommon case of a 16-year-old woman with type 1 neurofibromatosis and renovascular hypertension due to bilateral renal stenosis associated with asymptomatic digestive artery stenosis. Our patient was treated by several autologous bypasses to the superior mesenteric artery and the left and right renal arteries. She had no postoperative complications and good clinical and imaging outcomes at 10 years. Read More

Pediatr Radiol 2021 03 5;51(3):419-426. Epub 2020 Nov 5.

Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX, 77030, USA.

Background: Children with suspected renal artery stenosis (RAS) are screened with renal Doppler ultrasonography or computed tomography (CT) angiography/magnetic resonance (MR) angiography depending on institutional preference. CT angiography produces images with superior resolution, allowing higher quality multiplanar two-dimensional reformats and three-dimensional reconstructions. However, there is a paucity of data in the literature regarding the utility and diagnostic performance of renal CT angiography in pediatric RAS. Read More

Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2020 Oct;42(5):691-695

Department of Vascular Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.

Refractory hypertension and renal insufficiency caused by Takayasu arteritis with renal arteries involved are difficult to treat with medicines.Instead,surgery is often recommended for refractory renovascular hypertension with renal artery stenosis of ≥70%.Although both open surgery and endovascular surgery have been applied,the preferred surgical strategy remains undetermined. Read More

Neurol India 2020 Sep-Oct;68(5):1220-1223

Neurosurgeon and Interventional Neuroradiologist of Cajuru University Hospital of Pontifical Catholic University of Paraná (HUC-PUC PR), Curitiba - Parana, Brazil.

Background: Fibromuscular dysplasia affects generally renal artery, causing renovascular hypertension. The most classical angiographic pattern, string-of-beads, can be found in cervical and more rarely in other arteries. With the advance of endovascular procedures techniques, the number of open surgeries is decreasing, and complications related to the selective catheterization of diseased vessels are increasing. Read More