A retrospective study was performed from year 2011 to 2018.
The study included 45 patients (25 females and 20 males),
mean age 52 ± 15.
Selection of patients was preformed by criteria displayed in Table 2.
|Suspected secondary arterial hypertension
||Age over 18
|Renal transplant patients
|Suspected renal trauma
||Previous severe allergic reactions to iodine contrast
The method of examination was MDCT contrast angiography,
with the use of 2D and 3D software postprocessing (Multi Planar Reformation,
Maximum Intensity Projection,
Curved Planar Reformations,
transaxial view editing,
We analyzed vessel lumen and wall morphology,
renal parenchyma and possible cause of disease.
During vessel lumen analysis,
we detected presence of stenosis or aneurysm; in a case of stenosis we analyzed its localization and percentage.
- Vessel lumen and wall morphology
Stenosis was the most common finding,
which is to be expected since almost all renal artery diseases can lead to stenosis.
It was usually located ostially and in the proximal segment of the artery (32 patients).
It was located in the middle third of the artery in 5 of our patients,
and 2 patients had stenosis in the distal third of the vessel.
There were 28 patients with hemodynamically insignificant (25.6 ± 18.5%) and 10 patients with hemodynamically significant stenosis (80 ± 14.5%).
A potential problem that can occur while determining the degree of stenosis in RAD is the inability to find a suitable proximal reference point in cases where stenosis is present at vessel origin.
We overcame this obstacle by choosing the option to only pick one reference point,
which our software allows us to do.
Aneurysms were found in 3 of our patients.
They were found in patients with FMD,
and as an isolated finding.
- Renal parenchyma morphology
In younger patients,
no changes to the parenchyma morphology were registered.
In older patients,
chronic RAD led to renal atrophy,
with reduction of cortical thickness and poor corticomedular differentiation.
The renal transplant candidates often have multicystic kidney disease,
with enlarged kidneys and many simple cysts of varying size that take up most of the parenchyma.
- Causes of renal arterial disease
The most common underlying disease in our patient group was atherosclerosic disease (Table 3).
In cases where atherosclerosis was the underlying cause of RAD,
the disease manifested on CTA as excentric stenosis at vessel origin or in the proximal segment,
with varying degrees of calcification,
whereas in FMD,
CTA showed smooth stenosis in the middle segment,
or multiple sequential stenoses with intermittent aneurysm formation ("string of pearls" appearance).
In one of our patients,
who had previously had a surgical intervention during which his right renal artery was injured,
acute thrombosis of said vessel developed,
which led to renal infarction.
See figures 11-16 for images of characteristic radiological features.