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 190/130Â mmHg) partially controlled with 2 antihypertensive medications. | Young adolescent with uncontrolled hypertension (BP 220/115Â 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 | Â |
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 50Â mg twice per day and hydrochlorothiazide 50Â mg/d | Metoprolol 50Â mg twice per day and hydrochlorothiazide 50Â mg a day | Atenolol 50Â mg & amlodipine 10Â mg daily |
Outcome | BP 120/70Â 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 |