ESPN 51th Annual Meeting

ESPN 2018


 
CALCIFIED RENAL ARTERY ANEURISM IN SOLITARY KIDNEY CAUSING HYPERTENSION
NESLIHAN GÜNAY 1 AYŞE SEDA PINARBAŞI 1 EZGI ÖKTENER 2 İSMAIL DURSUN 1 AYDIN TUNÇAY 3 DENIZ DEMIRCI 4 GÜVEN KAHRIMAN 5 MUAMMER HAKAN PYRAZOĞLU 1 RUHAN DÜŞÜNSEL 1

1- ERCIYES UNIVERSITY MEDICAL FACULTY, PEDIATRIC NEPHROLOGY, KAYSERI
2- ERCIYES UNIVERSITY MEDICAL FACULTY, PEDIATRICS DEPARTMENT, KAYSERI
3- ERCIYES UNIVERSITY MEDICAL FACULTY,CARDIOVASCULAR SURGERY DEPARTMENT,KAYSERI
4- ERCIYES UNIVERSITY MEDICAL FACULTY, UROLOGY DEPARTMENT, KAYSERI
5- ERCIYES UNIVERSITY MEDICAL FACULTY, RADYODIAGNOSTIC DEPARTMENT, KAYSERI
 
Introduction:

 

Renal artery aneurysm (RAA) is a segment of a renal artery that dilated more than 2 times the diameter of a normal renal artery. The incidence of RAA is 0.01-0.3%. It is very rarely seen in children. Herein, we report a case presented with back pain, symptoms of hypertension due to calcified renal artery aneurysm in a solitary kidney.

Material and methods:

 

A 14-year-old boy who had been followed with essential hypertension four years, presented with complaint of back pain. He had no trauma history. His physical examination and laboratory findings were normal and blood pressure was high. His blood pressure was not able to control with three antihypertensive medications. Four years ago, USG and Doppler imaging performed were normal.

Plain abdominal radiography showed calcification measuring 4 cm at the level of the right renal artery. Computed tomography 3-dimensional (3D) reconstruction view detected calcification surrounding the right renal artery. On renal angiography, two segments of the renal artery were seen branching 1 cm apart from the abdominal aorta. It was seen that the segment above these two vessels was completely blocked and was not suitable for balloon dilatation. Since DMSA scintigraphy determined 29.68 % functioning right kidney, he was given a chance for surgery.  The calcified renal artery aneurysm was seen. The obstructive upper segment was remove and distal portion was connected to the lower renal artery by end-side anastomosis. Then, the blood pressure was decreased to normal limit. Unfortunately, two months after surgery, there was no functioning right kidney in the dynamic kidney scintigraphy.

Results:

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Conclusions:

Pediatric calcified RAA is often asymptomatic and strongly associated with hypertension, renal artery stenosis, and kidney failure. Ultrasonographic findings generally are nonspecific and may miss diagnosis. So, it should not be forgotten that renal artery aneurysm can be skipped by USG in patients with treatment-resistant hypertension.