Revista de informes de casos clínicos

A Curious Case of Hypertensive Emergency and Acute Kidney Injury

Abstract

Oluwaseun Oluwo, Dennis Hu, Ashkan Karimi, Garland Campbell and Negiin Pourafshar

A 75-year-old female with history of a prior right renal artery stent (coronary bare metal stent, duration 3 years), stage IV CKD (baseline serum creatinine (Scr) 2.1-2.3 mg/dL (eGFR 20-23 ml/min/1.73 m²)), diastolic heart failure, and hypertension. She had multiple hospital admissions for acute decompensated heart failure, now presenting with worsening dyspnea, increased oxygen requirements of 4 L oxygen via nasal canula, increased from baseline 2 L. Despite treatment with up to nine anti-hypertensive medications, her systolic BP remained 180-200 mmHg. Her Scr also increased to 3.92. Work-up showed normal kidney sizes and urine protein/creatinine ratio 1.26 g/g. Renal artery duplex revealed right renalartery peak systolic velocity 267 cm/sec, renal-to-aortic ratio 2.68, and resistive index 0.7-0.9, suggestive of right renal artery re-stenosis and some intrinsic damage. Due to progressive volume overload and worsening respiratory status, she required temporary hemodialysis. As her volume status improved, she underwent CO₂ angiogram and was found to have 90% diffuse in-stent restenosis with marked deformity of the previous stent. She underwent re-stenting of the right renal artery with a proprietary FDA-approved Herculink Elite® renal stent with only 8 ml of contrast. Immediately post-intervention, her BP dramatically improved and after two months, hemodialysis was stopped, (new baseline SCr 1.5-1.9) and she only required two BP medications.