Isolated renal artery dissection. Presentation, evaluation, management, and pathology

Brooks Sayre Edwards, A. W. Stanson, K. E. Holley, S. G. Sheps

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Isolated nontraumatic renal artery dissection is rare. In this communication, 35 cases are presented; 24 cases (group 1) (22 male, 2 female) were diagnosed angiographically, and 11 (group 2) (10 male, 1 female) were observed at autopsy. In group 1, 23 of the patients were hypertensive when they were first seen, and in 17 of them the hypertension was of recent onset. Additional presenting signs and symptoms included flank pain (10 patients), gross hematuria (5), and headaches (6). Renal function was satisfactory. Renal vein renin levels could be lateralized in 8 of 16 patients. Isotope renograms performed in 18 patients showed unilateral abnormalities in 7, bilateral abnormalities in 6, and normal results in 5. Angiograms showed that the dissection was unilateral in 18 cases and bilateral in 6 cases. Fibromuscular dysplasia was observed radiographically in 22 cases and was bilateral in 12. In group 1, 13 patients were treated with antihypertensive medication only, and 11 underwent operation. At follow-up (mean 52.0 months), the mean blood pressures were 128/89 mm Hg and 139/89 mm Hg for the medical and surgical groups, respectively. Eleven medical and nine surgical patients continued to require antihypertensive drugs at follow-up. Among the 11 patients in group 2, only 4 were hypertensive. In only one case the dissection may have contributed significantly to the patient's death. These studies indicate that isolated nontraumatic renal artery dissection most commonly occurs in young men with coexistent fibromuscular dysplasia. Hypertension is commonly present and therapy should be directed towards its control. In this study, blood pressure control was effectively accomplished with medical therapy.

Original languageEnglish (US)
Pages (from-to)564-571
Number of pages8
JournalMayo Clinic Proceedings
Volume57
Issue number9
StatePublished - 1982

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Renal Artery
Dissection
Pathology
Fibromuscular Dysplasia
Antihypertensive Agents
Blood Pressure
Hypertension
Renal Veins
Hematuria
Renin
Isotopes
Signs and Symptoms
Headache
Autopsy
Angiography
Kidney
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Isolated renal artery dissection. Presentation, evaluation, management, and pathology. / Edwards, Brooks Sayre; Stanson, A. W.; Holley, K. E.; Sheps, S. G.

In: Mayo Clinic Proceedings, Vol. 57, No. 9, 1982, p. 564-571.

Research output: Contribution to journalArticle

Edwards, Brooks Sayre ; Stanson, A. W. ; Holley, K. E. ; Sheps, S. G. / Isolated renal artery dissection. Presentation, evaluation, management, and pathology. In: Mayo Clinic Proceedings. 1982 ; Vol. 57, No. 9. pp. 564-571.
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