[Diagnostic and treatment of renovascular hypertension in the patient with horseshoe kidney]. / Dijagnosticki postupak i lijecenje renovaskularne hipertenzije u bolesnika s potkovastim bubregom.

A patient with renovascular hypertension and horseshoe kidney is presented. Diagnostic work-up consisted of ultrasonography, color-Doppler of renal arteries, dynamic scintigraphy with captopril test, separate renin, intravenous urography and computed tomography. Renal angiography revealed several aberrant renal arteries with significant fibromuscular dysplasia of the proximal artery of the right kidney. Contrast magnetic resonance of the kidneys with gadolinium was also performed. Following diagnostic procedure, a 5 mm balloon dilatation of the right proximal renal artery was performed. Immediate renal angiography showed no stenosis of the right proximal artery. The patient's blood pressure normalized after the invasive procedure. The diagnosis and treatment in the patient with renovascular hypertension due to fibromuscular dysplasia and horseshoe kidney are described. As renovascular hypertension is a rare diagnosis, this case report may help physicans recognize patients with this type of arterial hypertension.

[Renovascular hypertension--diagnosis and treatment]. / Renovaskularna hipertenzija--dijagnostika i lijecenje.

The approach and treatment of renovascular hypertension are presented. The study include 65 patients with severe arterial hypertension (31 men and 34 women), mean age 52 years, 26 of them with renovascular hypertension. Along with the usual diagnostic work-up, renal angiography using Seldinger method and renin measurement were performed in all patients through renal vein. Twelve patients underwent renal artery dilatation (PTRA), six patients kidney autotransplantation, and the rest were treated by medications. In nine patients, complete cure or improvement was achieved by PTRA, whereas unsuccessful renal artery dilatation was recorded in three patients. Surgical therapy for renovascular hypertension was used in six patients and proved successful. It is concluded that the earliest possible detection of renovascular hypertension is of utmost importance because this form of arterial hypertension is one of the most common potentially curable types of secondary hypertension. Concerning the methods of treatment, their invasiveness, and differences between various therapeutic procedures, it is important to make an algorithm of treatment for each individual patient.

[Renovascular hypertension due to Takayasu arteritis--a case report]. / Renovaskularna hipertenzija uzrokovana Takayasu arteritisom--prikaz bolesnice.

A 18-year old women with bilateral renal artery stenosis and renovascular hypertension as a part of Takayasu's disease is presented. Takayasu's disease is a chronic arteritis of unknown origin, primary affecting aorta and its branches. The disease is the most common in young women and is more common in the countries of eastern Asia in comparison with Western countries. Takayasu's disease can be severe and lifetreating disease. Mortality and morbidity depend on both the direct effect of the vascular lesions and the complications od disease. The mainstay of Takayasu's disease is based on the use of glucocorticoids alone or in association with cytotoxic drugs (cyclofosfamid, azatioprin, metotrexate). In the majority of cases, the partial control of disease is obtained.