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Accessory Renal Artery Stenosis and Secondary Hypertension

机译：辅助肾动脉狭窄和继发性高血压

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Background. Secondary hypertension is an uncommon cause of hypertension with extensive workup not recommended in most patients; however, further evaluation is generally recommended in young patients presenting with hypertension. Case Presentation. A 31-year-old female presented with history of elevated blood pressures. Secondary hypertension workup revealed no laboratory abnormalities; however, renal artery ultrasound demonstrated a left superior accessory artery and suspected bilateral renal vein congestion that was further evaluated with renal CT with contrast. Renal CT showed ostial stenosis of the left accessory renal artery. In addition, compression of the left renal vein between aorta and superior mesenteric artery was also noted, consistent with nutcracker syndrome. Hypertension was suspected to be secondary to stenosis of the accessory renal artery. Upon consultation with interventional radiology, pharmacologic treatment was recommended, and blood pressure control was ultimately achieved with a single agent. Discussion. Renovascular etiologies are responsible for 1% of cases of mild hypertension and up to 45% of severe hypertension. Accessory renal arteries are a normal anatomical variant in approximately 30% of the population. Secondary hypertension due to stenosis of an accessory renal artery is rare with very few cases described in case reports. Conclusion. Though hypertension secondary to accessory renal artery stenosis is rare and not well published in medical literature, few case reports, including this one, demonstrate that accessory renal artery stenosis can be an underlying etiology of hypertension.
机译：背景。继发性高血压是大多数患者在大多数患者中不推荐的高血压引起的;然而，通常推荐使用高血压的年轻患者进一步评估。案例演示。一名31岁女性患有血压升高的历史。继发性高血压次数显示没有实验室异常;然而，肾动脉超声证明了左级辅助动脉和可疑的双侧肾静脉充血，其进一步评价肾CT以对比度。肾CT显示出左辅助肾动脉的骨质狭窄。此外，还注意到左肾静脉的压缩，并注意到与胡桃夹综合征一致。怀疑高血压被怀疑是辅助肾动脉的狭窄。根据介入放射学咨询，推荐了药物治疗，并最终用单一试剂实现血压控制。讨论。肾血管病因均负责1％的轻度高血压病例，占严重高血压的45％。辅助肾动脉是大约30％的正常解剖变体。继发性肾动脉狭窄因患者报告中描述的案例而引起的继发性高血压是罕见的。结论。虽然高级肾脏动脉狭窄的高血压罕见，但在医学文献中发表罕见，但很少有案例报告，其中包括这一点，证明了附属肾动脉狭窄可以是高血压的潜在病因。

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