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Objectives: Renal transplantation is a well-accepted therapeutic option for patients with end stage renal disease. Renal artery stenosis occurring in a transplanted kidney is a potentially serious condition and adversely affects graft survival and prognosis. The objective of this study is to document the immediate and intermediate term clinical results of renal stenting in this rare subset of renal artery stenosis., Background: There is limited data about the effectiveness of renal stenting in transplant renal artery stenosis., Methods: Eight patients, aged between 22 and 51 (42.5 ± 9.25) years, were referred to our tertiary care interventional cardiology services for renal intervention. The diagnosis of transplant renal artery stenosis was based on clinical presentation (uncontrolled hypertension (n = 4, 50%), worsening renal function (n = 3, 37.5%) or flash pulmonary oedema (n = 1, 12.5%)] and Doppler ultrasound., Results: All patients had live donor renal transplant using end to end anastomosis 2 to 11 (6.25 ± 3.24) months prior to intervention. Angiography revealed discrete stenosis at the anastomotic site. Intrarenal stenting performed from femoral access using 6 F accessories produced excellent angiographic results. There were no access site or procedure related complications. The intervention produced excellent immediate and intermediate term clinical results. In three patients, there was stabilization of renal function during 62 ± 9.16 months of follow-up with decrease in serum creatinine by 38.86 ± 6.62 %; P = 0.0476. In four patients with refractory hypertension, excellent blood pressure control was achieved with a reduction in mean blood pressure by 25.95 ± 5.48 mm Hg (from 122.4 ± 5.7 to 96.45 ± 2.45 mm Hg; P = 0.0002) during 65.25 ± 23.79 months follow-up. There was decrease in antihypertensive drug requirement from 3.75 ± 0.5 to 1.75 ± 0.5. During follow-up, Doppler ultrasound documented a high peak systolic velocity in one asymptomatic patient with well controlled blood pressure and preserved renal function. Sustained benefits of percutaneous revascularization were supported by normal Doppler parameters in the remaining patients., Conclusions: Percutaneous renal stenting provides excellent angiographic and clinical results sustained at intermediate term follow-up in patients with symptomatic transplant renal artery stenosis., (Copyright © 2011 Wiley-Liss, Inc.)

Background: Malignant hypertension is now an uncommon entity in the western world but still remains a significant problem in India. Therefore we studied the aetiological spectrum, management, and outcome of these patients., Methods: Forty consecutive children (<16 years) with malignant hypertension were admitted and investigated to exclude or confirm the secondary causes of hypertension. For acute control of blood pressure sublingual nifedipine was used in dosage of 0.3-0.6 mg/kg, failing which intravenous nitroglycerin was used. In patients with aortoarteritis with active disease, steroids were used. Angioplasty was carried out for renal artery stenosis whenever possible., Results: Renoparenchymal disease was the commonest cause of malignant hypertension, and was seen in 25 cases, renovascular hypertension in 13 cases (11 aortoarteritis and two fibromuscular dysplasia) and two had essential hypertension. For acute control of severe hypertension, sublingual nifedipine was effective in 92.5% of patients. Of the patients with renoparenchymal disease five became normotensive with treatment of the underlying disease, four received renal allograft, seven died, and nine are stable on antihypertensive drugs. Renal angioplasty was carried out in seven patients with renovascular hypertension (4 cured, 3 improved) and six are controlled on drugs., Conclusions: We conclude that apart from renoparenchymal disease, aortoarteritis is a common cause of malignant hypertension in children. Sublingual nifedipine is effective for the rapid control of severe hypertension, and angioplasty is effective in aortoarteritis for short-term preservation of renal function and control of hypertension.

Occurrence of renovascular hypertension and its etiology is described in this work as seen in north India. Out of 2395 young hypertensives admitted for evaluation during the years 1978-1983, 91 patients (3.8%) were found to be having renovascular hypertension. In all patients suspected diagnosis of RVH was confirmed by the angiography of aorta and main vessels. Idiopathic aortoarteritis, diagnosed in 54 patients (59.4%) was the commonest cause of renovascular hypertension. In this group renal arterial involvement was found to be bilateral in 26 patients. Twenty-eight patients had isolated renal artery stenosis of unknown etiology. Six had fibromuscular dysplasia, 2 had polyarteritis and one had renal artery aneurysm. Twenty-three patients underwent surgery which included autotransplantation, arterial by-pass and nephrectomy with improved blood pressure control in 15. It is concluded that aortoarteritis seems to be the major cause of renovascular hypertension in the young in this part of the world.