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Adverse outcomes of renovascular hypertension during pregnancy

Nature Clinical Practice Nephrology volume 2, pages 651–656 (2006)Cite this article

Abstract

Background A 26-year-old primigravida, with no history of hypertension, presented at 20 weeks of gestation with severe pre-eclampsia. A pelvic ultrasound revealed intrauterine fetal death, probably caused by placental abruption. The pregnancy was terminated by induction with oxytocin, followed by a vaginal breech delivery. The patient remained hypertensive for 8 weeks after delivery.

Investigations Physical examination, laboratory investigation, renal angiogram and renal-vein renin sampling.

Diagnosis An atrophic right kidney secondary to an occluded right renal artery, probably caused by dissected fibromuscular dysplasia; a contralateral high-grade stenosis secondary to fibromuscular dysplasia.

Management Right nephrectomy and angioplasty of the left renal artery.

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Figure 1: Renal arteriograms with contrast showing (A) occluded right renal artery, (B) fibromuscular dysplasia of the middle left renal artery and (C) successful treatment with angioplasty.
Figure 2: Histology of the surgically removed right kidney showing: ischemic wrinkling and thickening of the glomerular basement membrane with mild mesangial matrix expansion (white arrow); thickening of the tubular basement membranes (black arrow) with patchy lymphocytic interstitial infiltrate.

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Author information

Authors and Affiliations

  1. B Thorsteinsdottir is a senior associate consultant in Community Internal Medicine, Mayo Clinic, and Instructor in Medicine, Mayo Medical School, Rochester, MN, USA

    Bjorg Thorsteinsdottir

  2. Cardiovascular Diseases at Mayo Clinic and Instructor in Medicine, Mayo Medical School, Rochester, MN, USA

    Garvan C Kane

  3. Division of Maternal and Fetal Medicine, Mayo Clinic and Professor in Obstetrics and Gynecology, Mayo Medical School, Rochester, MN, USA

    Michael J Hogan

  4. Laboratory Medicine and Pathology and Associate Dean for Academic Affairs, Mayo Medical School, Rochester, MN, USA

    William J Watson

  5. Nephrology and Hypertension at Mayo Clinic and Assistant Professor of Medicine, Mayo Medical School, Rochester, MN, USA

    Joseph P Grande

  6. Regional International Medicine and Program Director for Clinical Reviews at Mayo Clinic, Scottsdale, AZ, USA

    Vesna D Garovic

Authors
  1. Bjorg Thorsteinsdottir
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  2. Garvan C Kane
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  3. Michael J Hogan
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  4. William J Watson
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  5. Joseph P Grande
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  6. Vesna D Garovic
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Corresponding author

Correspondence to Vesna D Garovic.

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The authors declare no competing financial interests.

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Thorsteinsdottir, B., Kane, G., Hogan, M. et al. Adverse outcomes of renovascular hypertension during pregnancy. Nat Rev Nephrol 2, 651–656 (2006). https://doi.org/10.1038/ncpneph0310

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