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Renal Arteriographic Data of Young Male Patients with Suspected Renovascular Hypertension
Archives of Medical Research 36 (2005) 418–420
BRIEF REPORT
Renal Arteriographic Data of Young Male Patients with Suspected Renovascular Hypertension Enes Murat Atasoyu,a Suat Unver,a T. Rifki Evrenkayaa and Cinar Basekimb a
Departments of Nephrology and bRadiodiagnostic Radiology, Gulhane Military Academy of Medicine, Haydarpasa Training Hospital, Istanbul, Turkey Received for publication October 1, 2004; accepted January 3, 2005 (D-04-00102).
The aim of the study was to determine whether the anatomical variant in which one or more renal vessels arose from the aorta was associated with hypertension in young male patients. We investigated the renal arteriographic data of 73 young male patients (age: 27.4 ⫾ 7.4, blood pressure: 162.7 ⫾ 17.5/104.6 ⫾ 10.1 mmHg) with grade-II hypertension. All studied patients underwent angiography to exclude renal artery stenosis. The patients were divided into two groups on the basis of their renal angiograms. We determined no abnormal findings in 33 renal arteriograms (45.2%). Twenty three (31.5%) patients had an additional renal artery without renal artery stenosis or renal anatomical variations. In conclusion, although the significance of this form of hypertension is still largely obscure, we believe that the presence of additional renal arteries may be associated with hypertension. 쑖 2005 IMSS. Published by Elsevier Inc. Key Words: Hypertension, Additional renal artery, Arteriography, Young males.
Introduction Blood pressure is regulated by neurogenic, hormonal, nutritional, biochemical, and structural mechanisms. These mechanisms are all integrated, so that alterations in one frequently result in modifications of others. Because of the complexity of these interrelations, the mechanism(s) responsible for the development and maintenance of essential hypertension remain largely unknown, despite intensive and continuing research. A link between the emergence of arterial hypertension and the presence of additional renal arteries has long been suspected. The probability of such an association has been suggested in numerous studies (1,2). One suggested hypothesis to explain hypertension with associated additional renal arteries is that a renal segment dependent on an additional artery might secrete relatively more renin than the other segments of the renal parenchyma, the reason being that such arteries are usually of a considerably smaller caliber than the main trunk (1).
Address reprint requests to: Dr. Enes Murat Atasoyu, GATA Haydarpasa Egitim Hastanesi, Nefroloji Servisi, 34668 Kadikoy-Istanbul, Turkey. Phone: (⫹90) (216) 542-2444; FAX: (⫹90) (216) 542-2444; E-mail: [email protected]
0188-4409/05 $–see front matter. Copyright d o i : 10 .1 0 1 6/ j.ar c med .2 0 05 .0 3 .0 2 5
The aim of the study was to determine whether the anatomical variant in which one or more renal vessels arose from the aorta was associated with hypertension in young male patients. Subjects and Methods Between November 2000 and December 2003, we investigated the renal angiographic data of 73 young male patients (age: 27.4 ⫾ 7.4, blood pressure: 162.7 ⫾ 17.5/104.6 ⫾ 10.1 mmHg) with grade II and grade III hypertension. All studied patients underwent angiography to exclude renal artery stenosis. The patients were divided into two groups on the basis of their renal angiograms: Group A consisted of patients with single renal arteries, and Group B consisted of patients with additional renal arteries or other renal anomalies. Renal arteriography was performed as intra-arterial subtraction angiography, with the insertion of a #4 French pigtail catheter and automatic injection of contrast medium. Measurements of the biochemical parameters (levels of serum cholesterol, triglycerides, creatinine, sodium, potassium, and hematocrit values) were obtained from blood drawn for routine analysis after a 12-h fasting period. All measurements were performed by the resident physician in the internal medicine clinic with the same instrument,
쑖 2005 IMSS. Published by Elsevier Inc.
Suspected Renal Hypertension in Young Males
using a blood pressure gauge manufactured by Erka Co. (Bad To¨lz, Germany). Blood pressure assessment was performed according to the seventh report of the Joint National Committee (JNC-VII). Analysis of the angiograms for additional renal arteries was carried out by a certified radiologist. Cases in which one or more additional arterial vessels arose directly in the aorta were classified as having additional renal arteries. Patients were excluded if the level of serum creatinine exceeded 1.2 mg/dL. Statistical analysis. SPSS-11 software was used to for statistical analysis. Results were presented as mean ⫾ standard deviation. The Mann-Whitney U test was used to compare two independent groups. Values of p ⬍0.05 were regarded as significant.
Results Clinical and laboratory characteristics of the patients are shown in Table 1. No significant differences were found between Group A and Group B in terms of age, blood levels, body mass index (BMI), use of antihypertensive agents, hematocrit values, serum cholesterol levels, or triglycerides. We determined no abnormal findings in 33 renal arteriographic studies (45.2%). Data concerning 40 (54.8%) patients with renal arterial and extra-arterial abnormalities are shown in Table 2. In Group B, 23 (31.5%) patients had only additional renal arteries without renal artery stenosis or renal anatomical anomalies.
419
Table 2. Abnormal angiographic findings Abnormalities Unilateral additional renal arteries Right-sided first additional renal artery Left-sided first additional renal artery Bilateral first additional renal artery Left-sided first and second additional renal arteries Bilateral first and second additional renal arteries Left-sided first additional renal artery and right-sided first and second additional renal arteries Right-sided renal artery stenosis Right-sided renal artery stenosis and left-sided first additional renal artery A left-sided accessory superior renal artery originated from the renal artery Left-sided renal vein anomaly Horseshoe kidney and coarctation of aorta Bilateral first additional renal arteries and coarctation of aorta Coarctation of aorta Right-sided renal atrophy Left-sided renal atrophy Bilateral simple cysts Nephrolithiasis Total
Number of patients
%
18
24.6
11
15
7
9.5
2
2.7
1
1.3
1
1.3
1
1.3
2 1
2.7 1.3
1
1.3
3 1
4.1 1.3
1
1.3
1 2 1 1 3 40
1.3 2.7 1.3 1.3 4.1 54.8
Discussion In this study we aimed to determine whether the anatomical variant in which one or more renal vessels arose from the aorta was associated with hypertension in young male patients suspected of having renovascular hypertension.
We demonstrated that 40 (54.8%) out of 73 hypertensive patients studied had renal arterial and extra-arterial abnormalities. In Group B, 23 (31.5%) patients had only additional
Table 1. Clinical features and laboratory parameters of the patients Renal artery anomalies Characteristics Number of patients Age (years) Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg) BMI (kg/m2) Cholesterol (mg/dL) Triglycerides (mg/dL) Creatinine (mg/dL) Hematocrit (%)
Group A (present)
Group B (absent)
p value
40 28.1 ⫾ 7.3 162.5 ⫾ 14.4 102.6 ⫾ 8.1 24.8 ⫾ 3.4 172.8 ⫾ 32 117.3 ⫾ 44.3 0.9 ⫾ 0.3 44.1 ⫾ 2.3
33 26 ⫾ 5.7 164.1 ⫾ 18.3 105 ⫾ 11.6 25.4 ⫾ 3.4 165.5 ⫾ 35 146.2 ⫾ 96.2 0.7 ⫾ 0.4 45.8 ⫾ 3.4
⬍0.05 ⬎0.05 ⬎0.05 ⬎0.05 ⬎0.05 ⬎0.05 ⬎0.05 ⬎0.05 ⬎0.05
420
Murat Atasoyu et al. / Archives of Medical Research 36 (2005) 418–420
renal artery without renal artery stenosis or other renal anatomical anomalies. Satyapal et al. (2001) reported the incidence of first and second additional renal arteries as 27.7% (3). Bonner et al. (4) found that the frequency of multiple renal arteries in 394 aortograms was 29.2%, and that a comparison of hypertensive and normotensive groups showed no significant difference in the frequency of additional renal arteries (4). Nomura et al. (2) reported that blood pressure was significantly higher in patients with additional renal arteries than in patients with single renal arteries (2). Glodny et al. (1) showed that patients with additional renal artery anomalies exhibit significantly higher blood pressure than patients with normal renal anatomies (1). Although the significance of this form of hypertension is still largely obscure, we believe that the presence of one
or more additional renal arteries may be associated with hypertension.
References 1. Glodny B, Cromme S, Reimer P, Lennarz M, Winde G, Vetter H. Hypertension associated with multiple renal arteries may be renin-dependent. J Hypertens 2000;18:1437–1444. 2. Nomura G, Kurosaki M, Kondo T, Takeuchi J. Essential hypertension in multiple renal arteries. Am Heart J 1971;81:274–280. 3. Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries: incidence and morphometry. Surg Radiol Anat 2001;23:33–38. 4. Bonner G, Dreesbach H, Helber A, Kaufmann W. Hypertension and multiple renal arteries. Comparative studies on the frequency of multiple renal arteries in hypertensive patients and normotensives. Dtsch Med Wochenschr 1978;103:345–349.
BRIEF REPORT
Renal Arteriographic Data of Young Male Patients with Suspected Renovascular Hypertension Enes Murat Atasoyu,a Suat Unver,a T. Rifki Evrenkayaa and Cinar Basekimb a
Departments of Nephrology and bRadiodiagnostic Radiology, Gulhane Military Academy of Medicine, Haydarpasa Training Hospital, Istanbul, Turkey Received for publication October 1, 2004; accepted January 3, 2005 (D-04-00102).
The aim of the study was to determine whether the anatomical variant in which one or more renal vessels arose from the aorta was associated with hypertension in young male patients. We investigated the renal arteriographic data of 73 young male patients (age: 27.4 ⫾ 7.4, blood pressure: 162.7 ⫾ 17.5/104.6 ⫾ 10.1 mmHg) with grade-II hypertension. All studied patients underwent angiography to exclude renal artery stenosis. The patients were divided into two groups on the basis of their renal angiograms. We determined no abnormal findings in 33 renal arteriograms (45.2%). Twenty three (31.5%) patients had an additional renal artery without renal artery stenosis or renal anatomical variations. In conclusion, although the significance of this form of hypertension is still largely obscure, we believe that the presence of additional renal arteries may be associated with hypertension. 쑖 2005 IMSS. Published by Elsevier Inc. Key Words: Hypertension, Additional renal artery, Arteriography, Young males.
Introduction Blood pressure is regulated by neurogenic, hormonal, nutritional, biochemical, and structural mechanisms. These mechanisms are all integrated, so that alterations in one frequently result in modifications of others. Because of the complexity of these interrelations, the mechanism(s) responsible for the development and maintenance of essential hypertension remain largely unknown, despite intensive and continuing research. A link between the emergence of arterial hypertension and the presence of additional renal arteries has long been suspected. The probability of such an association has been suggested in numerous studies (1,2). One suggested hypothesis to explain hypertension with associated additional renal arteries is that a renal segment dependent on an additional artery might secrete relatively more renin than the other segments of the renal parenchyma, the reason being that such arteries are usually of a considerably smaller caliber than the main trunk (1).
Address reprint requests to: Dr. Enes Murat Atasoyu, GATA Haydarpasa Egitim Hastanesi, Nefroloji Servisi, 34668 Kadikoy-Istanbul, Turkey. Phone: (⫹90) (216) 542-2444; FAX: (⫹90) (216) 542-2444; E-mail: [email protected]
0188-4409/05 $–see front matter. Copyright d o i : 10 .1 0 1 6/ j.ar c med .2 0 05 .0 3 .0 2 5
The aim of the study was to determine whether the anatomical variant in which one or more renal vessels arose from the aorta was associated with hypertension in young male patients. Subjects and Methods Between November 2000 and December 2003, we investigated the renal angiographic data of 73 young male patients (age: 27.4 ⫾ 7.4, blood pressure: 162.7 ⫾ 17.5/104.6 ⫾ 10.1 mmHg) with grade II and grade III hypertension. All studied patients underwent angiography to exclude renal artery stenosis. The patients were divided into two groups on the basis of their renal angiograms: Group A consisted of patients with single renal arteries, and Group B consisted of patients with additional renal arteries or other renal anomalies. Renal arteriography was performed as intra-arterial subtraction angiography, with the insertion of a #4 French pigtail catheter and automatic injection of contrast medium. Measurements of the biochemical parameters (levels of serum cholesterol, triglycerides, creatinine, sodium, potassium, and hematocrit values) were obtained from blood drawn for routine analysis after a 12-h fasting period. All measurements were performed by the resident physician in the internal medicine clinic with the same instrument,
쑖 2005 IMSS. Published by Elsevier Inc.
Suspected Renal Hypertension in Young Males
using a blood pressure gauge manufactured by Erka Co. (Bad To¨lz, Germany). Blood pressure assessment was performed according to the seventh report of the Joint National Committee (JNC-VII). Analysis of the angiograms for additional renal arteries was carried out by a certified radiologist. Cases in which one or more additional arterial vessels arose directly in the aorta were classified as having additional renal arteries. Patients were excluded if the level of serum creatinine exceeded 1.2 mg/dL. Statistical analysis. SPSS-11 software was used to for statistical analysis. Results were presented as mean ⫾ standard deviation. The Mann-Whitney U test was used to compare two independent groups. Values of p ⬍0.05 were regarded as significant.
Results Clinical and laboratory characteristics of the patients are shown in Table 1. No significant differences were found between Group A and Group B in terms of age, blood levels, body mass index (BMI), use of antihypertensive agents, hematocrit values, serum cholesterol levels, or triglycerides. We determined no abnormal findings in 33 renal arteriographic studies (45.2%). Data concerning 40 (54.8%) patients with renal arterial and extra-arterial abnormalities are shown in Table 2. In Group B, 23 (31.5%) patients had only additional renal arteries without renal artery stenosis or renal anatomical anomalies.
419
Table 2. Abnormal angiographic findings Abnormalities Unilateral additional renal arteries Right-sided first additional renal artery Left-sided first additional renal artery Bilateral first additional renal artery Left-sided first and second additional renal arteries Bilateral first and second additional renal arteries Left-sided first additional renal artery and right-sided first and second additional renal arteries Right-sided renal artery stenosis Right-sided renal artery stenosis and left-sided first additional renal artery A left-sided accessory superior renal artery originated from the renal artery Left-sided renal vein anomaly Horseshoe kidney and coarctation of aorta Bilateral first additional renal arteries and coarctation of aorta Coarctation of aorta Right-sided renal atrophy Left-sided renal atrophy Bilateral simple cysts Nephrolithiasis Total
Number of patients
%
18
24.6
11
15
7
9.5
2
2.7
1
1.3
1
1.3
1
1.3
2 1
2.7 1.3
1
1.3
3 1
4.1 1.3
1
1.3
1 2 1 1 3 40
1.3 2.7 1.3 1.3 4.1 54.8
Discussion In this study we aimed to determine whether the anatomical variant in which one or more renal vessels arose from the aorta was associated with hypertension in young male patients suspected of having renovascular hypertension.
We demonstrated that 40 (54.8%) out of 73 hypertensive patients studied had renal arterial and extra-arterial abnormalities. In Group B, 23 (31.5%) patients had only additional
Table 1. Clinical features and laboratory parameters of the patients Renal artery anomalies Characteristics Number of patients Age (years) Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg) BMI (kg/m2) Cholesterol (mg/dL) Triglycerides (mg/dL) Creatinine (mg/dL) Hematocrit (%)
Group A (present)
Group B (absent)
p value
40 28.1 ⫾ 7.3 162.5 ⫾ 14.4 102.6 ⫾ 8.1 24.8 ⫾ 3.4 172.8 ⫾ 32 117.3 ⫾ 44.3 0.9 ⫾ 0.3 44.1 ⫾ 2.3
33 26 ⫾ 5.7 164.1 ⫾ 18.3 105 ⫾ 11.6 25.4 ⫾ 3.4 165.5 ⫾ 35 146.2 ⫾ 96.2 0.7 ⫾ 0.4 45.8 ⫾ 3.4
⬍0.05 ⬎0.05 ⬎0.05 ⬎0.05 ⬎0.05 ⬎0.05 ⬎0.05 ⬎0.05 ⬎0.05
420
Murat Atasoyu et al. / Archives of Medical Research 36 (2005) 418–420
renal artery without renal artery stenosis or other renal anatomical anomalies. Satyapal et al. (2001) reported the incidence of first and second additional renal arteries as 27.7% (3). Bonner et al. (4) found that the frequency of multiple renal arteries in 394 aortograms was 29.2%, and that a comparison of hypertensive and normotensive groups showed no significant difference in the frequency of additional renal arteries (4). Nomura et al. (2) reported that blood pressure was significantly higher in patients with additional renal arteries than in patients with single renal arteries (2). Glodny et al. (1) showed that patients with additional renal artery anomalies exhibit significantly higher blood pressure than patients with normal renal anatomies (1). Although the significance of this form of hypertension is still largely obscure, we believe that the presence of one
or more additional renal arteries may be associated with hypertension.
References 1. Glodny B, Cromme S, Reimer P, Lennarz M, Winde G, Vetter H. Hypertension associated with multiple renal arteries may be renin-dependent. J Hypertens 2000;18:1437–1444. 2. Nomura G, Kurosaki M, Kondo T, Takeuchi J. Essential hypertension in multiple renal arteries. Am Heart J 1971;81:274–280. 3. Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries: incidence and morphometry. Surg Radiol Anat 2001;23:33–38. 4. Bonner G, Dreesbach H, Helber A, Kaufmann W. Hypertension and multiple renal arteries. Comparative studies on the frequency of multiple renal arteries in hypertensive patients and normotensives. Dtsch Med Wochenschr 1978;103:345–349.