eMedicine Specialties > Radiology > Genitourinary
Renal Artery Stenosis/Renovascular Hypertension: Multimedia
Updated: Oct 2, 2009
Multimedia
 | Media file 1: Renal artery stenosis/renovascular hypertension. Left, Sonograms of the kidneys on a 57-year-old woman with difficult-to-control hypertension shows kidneys of uneven sizes: The left kidney is 96 mm, and the right kidney is 63 mm. Top right, Isotopic renogram (obtained with technetium mercaptoacetyltriglycine [MAG3]) after captopril shows a markedly depressed renal function in the right kidney. Bottom right, Analogous images show negligible activity in the right kidney. Note that this pattern is more typical for DTPA than MAG3 (as DTPA depends on the glomerular filtration rate for uptake which is decreased after captopril in renovascular hypertension [RVHT]). In severe cases of RVHT, MAG3 uptake can be decreased, as in this case. However, typically, uptake is preserved with decreased cortical excretion. |
 | Media file 2: Renal artery stenosis/renovascular hypertension: Sonograms of the kidneys of a 46-year-old woman with difficult-to-control hypertension showing uneven sizes of the kidneys. The right kidney is 2.5 cm smaller in size. An isotope renogram obtained with technetium mercaptoacetyltriglycine (Tc-MAG3) shows renal function in the right kidney (purple) to be markedly depressed. |
 | Media file 3: Renal artery stenosis/renovascular hypertension. Left, Flush aortogram in a 63-year-old man with hypertension shows marked stenosis of the right renal artery and complete occlusion of the left renal artery. Note the extensive atheroma in the aorta and iliac arteries. Right, nephrogram-phase image shows a significantly smaller left kidney with a faint nephrogram. Some blood supply to the left kidney is retained via collaterals (see image on the left). |
 | Media file 4: Renal artery stenosis/renovascular hypertension. Digital subtraction flush aortogram in a 77-year-old normotensive man shows marked left renal artery stenosis and diffuse aortic atheroma. The patient presented with lower-limb claudication. |
 | Media file 5: Renal artery stenosis/renovascular hypertension. Digital subtraction flush aortogram in an 83-year-old mildly hypertensive man shows complete occlusion of the left renal artery; only a stub of the artery is visualized. Note the diffuse aortic atheroma. The patient presented with lower-limb claudication. |
 | Media file 6: Renal artery stenosis/renovascular hypertension. Three-dimensional phase-contrast magnetic resonance angiographic (MRA) images of normal renal arteries. |
 | Media file 7: Renal artery stenosis/renovascular hypertension. Dynamic gadolinium-enhanced magnetic resonance angiogram (MRA) shows normal renal arteries. |
 | Media file 8: Renal artery stenosis/renovascular hypertension. Flush aortogram in a 32-year-old man with familial hypercholesterolemia and difficult-to-control hypertension. Radiograph shows a complete occlusion of the right renal artery and marked stenosis of the left renal artery. |
 | Media file 9: Renal artery stenosis/renovascular hypertension. Left, A balloon angioplasty catheter is seen in situ across the left renal artery stenosis in the same patient as in Image 7 in Multimedia. Right, After angioplasty, an excellent anatomic (and functional) result was achieved. |
 | Media file 10: Renal artery stenosis/renovascular hypertension. Technetium mercaptoacetyltriglycine (Tc-MAG3) isotopic renogram in the same patient as in Images 8-9 in Multimediashows curves before and after angioplasty. |
 | Media file 11: Renal artery stenosis/renovascular hypertension. Digital subtraction flush aortogram in a patient with a right iliac fossa transplanted kidney. Image shows stenosis at the anastomotic site associated with post-stenotic dilatation. |
 | Media file 12: Renal artery stenosis/renovascular hypertension. Digital subtraction flush aortogram in a patient with a left iliac fossa transplanted kidney. Image shows an intrarenal branch stenosis associated with post-stenotic dilatation. |
 | Media file 13: Renal artery stenosis/renovascular hypertension. Differential diagnosis. Selective right renal angiogram shows standing waves in an intralobar artery. Standing waves in the renal arteries show as multiple serrated indentations that are symmetrically distributed at evenly spaced intervals. These of no pathologic significance and may represent arterial spasm. They may also affect intrarenal branches, as in this case. |
 | Media file 14: The patient is a 39-year-old man with Leriche syndrome. The abdominal aorta is completely occluded just below the origin of the renal arteries. The right renal artery is completely occluded. Angioplasty and stenting of these arteries can be attempted via the brachial artery. |
 | Media file 15: Image of a 39-year-old man with Leriche syndrome. The abdominal aorta is completely occluded just below the origin of the renal arteries. The right renal artery is completely occluded. Angioplasty and stenting of these arteries can be attempted via the brachial artery (same patient as in Image 14 in Multimedia). |
 | Media file 16: Image of a 39-year-old man with Leriche syndrome. The abdominal aorta is completely occluded just below the origin of the renal arteries. The right renal artery is completely occluded. Angioplasty and stenting of these arteries can be attempted via the brachial artery (same patient as in Images 14-15 in Multimedia). |
 | Media file 17: Image of a 39-year-old man with Leriche syndrome. The abdominal aorta is completely occluded just below the origin of the renal arteries. The right renal artery is completely occluded. Angioplasty and stenting of these arteries can be attempted via the brachial artery (same patient as in Images 14-16 in Multimedia). |
 | Media file 18: Image of a 39-year-old man with Leriche syndrome. Note the atrophic right kidney and stenosis of the left renal artery with post-stenotic dilatation. The abdominal aorta is completely occluded just below the origin of the renal arteries. The right renal artery is completely occluded. Angioplasty and stenting of these arteries can be attempted via the brachial artery. Angioplasty and stenting of these arteries can be attempted via the brachial artery (same patient as in Images 14-17 in Multimedia). |
More on Renal Artery Stenosis/Renovascular Hypertension |
| Overview: Renal Artery Stenosis/Renovascular Hypertension |
| Imaging: Renal Artery Stenosis/Renovascular Hypertension |
| Follow-up: Renal Artery Stenosis/Renovascular Hypertension |
 Multimedia: Renal Artery Stenosis/Renovascular Hypertension |
| References |
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Further Reading
Keywords
renal artery stenosis, renovascular hypertension, RAS, RVHT, atheromatous renal artery stenosis, renal artery fibrosing lesions, intimal fibroplasia, medial fibrosis with microaneurysms, subadventitial fibroplasia, fibromuscular hyperplasia, segmental mediolytic arteriopathy, renal ischemia, renin-angiotensin-aldosterone activation, arterial dysplasia, medial fibroplasia, MFP
