Kidney at risk: 11-year course of renal artery stenosis

In 1990, a 49-year-old woman with unstable angina was admitted for coronary angiography, which showed two-vessel disease. She had a 33-year history of hypertension and so renal angiography was also performed which revealed a non-stenosing atherosclerotic plaque in the proximal left renal artery (Figure 1A). Blood pressure was controlled with two antihypertensive drugs. The calculated creatinine clearance was 61 mlumin, and was unchanged since 1974. In 2001, aged 60, she was admitted again because of unstable angina. A coronary angiogram revealed three-vessel disease. Renal arteriography now showed a high-grade stenosis of the left renal artery where the plaque was seen 11 years before (Figure 1B). Blood pressure was still well controlled with three antihypertensive drugs. Renal function was unchanged. Captopril scintigraphy with Tc-mercaptoacetyltriglycine (MAG3) showed equal perfusion of both kidneys, but severely impaired glomerular filtration on the left side indicated by massively enhanced tracer accumulation in a later phase (Figure 2A). This confirmed the haemodynamic significance of the angiographic finding. Percutaneous transluminal angioplasty with stent implantation was performed