Renal artery stenosis causing hypertension

Q: My son, who is 24 years old, has come to know during a medical check-up that he is suffering from high blood pressure which ranges between 180/120 (Rt.), 160/100 (Lt), 150/100. One of the tests advised by the CGHS doctor was Doppler Ultrasound for kidneys and the report is as follows: Doppler evaluation of the renal vessels revealed a normal trace on the right side with normal value of acceleration time and acceleration index. The left kidney revealed a parous et tardus wave form in the arcuate vessels of the lower polar region with significant increase in acceleration time and acceleration index highly suspicious for segmental arterial compromise. My questions are: 1. What is Segmental left renal artery stenosis? and can this be a possible cause for high blood pressure as stated above. 2. What is renal angiography/MR angiography? 3. What is the treatment for this disease? Which is the best and well equipped hospital in Delhi for treatment of this disease?

A:Segmental left renal artery stenosis means that a smaller sub-division of the main left renal artery (the artery which supplies blood to the left kidney) appears to be narrower than normal. This can lead to liberation of certain substances in the blood from the kidney, which results in high blood pressure. This is a well recognised cause of secondary hypertension (high blood pressure where there is an attributable reason). However, doppler can only be used as a screening investigation to pick up cases with high probability of the disease. The confirmation can be had only on a conventional renal angiography whereby a catheter is introduced into the renal (kidney) artery via a puncture made in the skin over the groin area. Once there, a special dye is injected and pictures taken which delineate the vessels – the renal artery and its branches. MR angiography is a non invasive method which takes the help of MRI machine and does not need a skin puncture to be made and the catheter placed in the aorta or renal arteries. The treatment of this disease (if confirmed) is angioplasty (if feasible as shown on angiography). All multispeciality and big hospitals like Sir Ganga Ram Hospital, Apollo hospital, Batra hospital in the private sector and AIIMS in the government sector should be able to handle such cases.