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Table 1 Summary of case reports previously reported in the literature

From: Renin dependent hypertension caused by accessory renal arteries

 

Patient 1 (reference [15])

Patient 2 (reference [15])

Patient 3 (reference [21])

Clinical

Patient with severe hypertension (BP 190/130 mmHg) partially controlled with 2 antihypertensive medications.

Young adolescent with uncontrolled hypertension (BP 220/115 mmHg) treated with beta blocker and diuretic.

Uncontrolled hypertension in a young patient investigated for secondary hypertension.

Hormonal studies

PA 15 ng/dL

PRA 8 ng/ml/hour

ARR 1.8

PA 23 ng/dL

PRA 18 ng/ml/hour

ARR 1.3

Supine renin 400 pg/mL (Normal 2.4–21.9)

Selective renal vein sampling

Renin vein (right/left) ratio 4.3:1 after captopril

Renin vein (right/left) ratio 8:1 after captopril

 

Imaging

Arteriogram showed elongated, nonstenotic aberrant artery arising from the common iliac artery supplying the lower pole of the right kidney

Arteriogram showed nonstenotic aberrant artery arising from the lower aorta feeding the lower pole of the left kidney

Digital subtraction angiography showed small (2-mm) left accessory RA entrapped by the diaphragmatic crus with 90% proximal ostial segment stenosis

Medication

Propranolol 50 mg twice per day and hydrochlorothiazide 50 mg/d

Metoprolol 50 mg twice per day and hydrochlorothiazide 50 mg a day

Atenolol 50 mg & amlodipine 10 mg daily

Outcome

BP 120/70 mmHg off antihypertensive after left partial nephrectomy.

Medical therapy with captopril, diuretic and beta blocker. Subsequently lost to follow up.

Decision was made for medical therapy

  1. PA plasma aldosterone expressed in ng/dl [conversion factor to SI (pmol/L = 27.741], PRA plasma renin activity