PMC4352654_01
Multidetector-row computed tomography images of the kidneys and vessels demonstrating occlusion of left renal artery, atrophy of left kidney, and mild stenosis of right renal artery. a Coronal plane view. b Three-dimensional view. Note that vessels collateral to the left renal artery around the left kidney were rich
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Fig1
MDCT showed occlusion of the left renal artery, atrophy of the left kidney, and mild stenosis of the right renal artery (Fig. 1a, b).
99mTc-mercaptoacetyltriglycine (99mTc-MAG3) renogram. The effective renal plasma flow of the left kidney markedly decreased and showed no peak curve
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Fig2
Collateral vessels to the left renal artery around the left kidney were identified, and the left renal artery was determined to have chronic total occlusion. 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) renography revealed a marked decrease in the effective renal plasma flow of the left kidney (left side, 22.7 ml/min; right side, 247.2 ml/min), and no peak curve of the left kidney on renogram (Fig. 2), suggesting that the left kidney might have no residual renal function.
Digital subtraction abdominal and renal angiography. a Aortic angiography. b The right renal artery showing mild stenosis of the proximal portion. c The left renal artery showing total occlusion. A artery, Rt right, Lt left, SMA superior mesenteric artery
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Fig3
Aortic angiography showed mild stenosis of the right kidney artery and total occlusion of the left kidney artery (Fig. 3a-c).
a Percutaneous renal angioplasty (PTRA). b Renal angiography after PTRA
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Fig4
A 0.014-inch guide wire (Shevalier; Cordis, East Bridgewater, NJ, USA) was able to cross into the distal true channel (Fig. 4a). After predilatation, a 5.0 x 18-mm stent (Palmaz Gensis; Cordis) was deployed across the lesion at 14 atm with a good final result, and the blood flow of the left renal artery was completely recovered (Fig. 4b).
a Clinical course. CR controlled release, PRA plasma renin activity, PAC plasma aldosterone concentration, Nic nicardipine, PTRA percutaneous transluminal renal angioplasty. b
99mTc-MAG3 renogram after PTRA. c
99mTc-MAG3 renogram 1 year after PTRA
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Fig5
The next day, blood pressure decreased gradually to 100-120/60-80 mmHg after PTRA, and methyldopa was discontinued (Fig. 5a). Before discharge, both the PRA and PAC were much lower than on admission, 0.2 ng/ml/h and 96.5 pg/ml, respectively. 99mTc-MAG3 renography revealed a moderate decrease in the effective renal plasma flow of the right kidney and a mild increase in that of the left kidney (left side, 53.0 ml/min; right side, 199.7 ml/min) (Fig. 5b).      Compared with previous findings, the renogram revealed a peak curve of the left kidney (Fig. 5c), and further increase in the effective renal plasma flow of the left kidney (77.1 ml/min) and a decrease in that of the right kidney (179.7 ml/min) (Fig. 6).
Split renal function shift after PTRA. ERPF effective renal plasma flow
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Fig6
Compared with previous findings, the renogram revealed a peak curve of the left kidney (Fig. 5c), and further increase in the effective renal plasma flow of the left kidney (77.1 ml/min) and a decrease in that of the right kidney (179.7 ml/min) (Fig. 6).
Computed tomography images of the kidneys demonstrating improvement in atrophy of the left kidney. a Before PTRA. b One year after PTRA
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Fig7
Furthermore, the computed tomogram demonstrated an improvement in the atrophy of the left kidney (Fig. 7a, b), and the kidney function also improved to a serum creatinine level of 0.74 mg/dl.