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. Author manuscript; available in PMC: 2017 Mar 1.

Published in final edited form as: Curr Opin Nephrol Hypertens. 2016 Mar;25(2):144–151. doi: 10.1097/MNH.0000000000000202

(A) Serum creatinine, blood pressure and medications over an eight year period in a patient with unilateral atherosclerotic renovascular disease associated with a nonfunctioning kidney (less than 5% by renal scan). This patient developed severe hypertension that responded well to a regiment based upon an angiotensin receptor blocker (valsartan). Several years later, however, she developed worsening renal failure with an eGFR = 16 ml/min/1.73m2, leading to evaluation for kidney transplantation. Her disease was managed conservatively, but she developed severe hypertension and worsening renal function (creatinine above 5.0 mg/dL), leading her physician to withhold the ARB. Serum creatinine fell, although blood pressure was difficult to control and she developed episodes of acute pulmonary edema. (B) Doppler ultrasound identified a stenosis to her remaining functional kidney (peak systolic velocity above 500 cm/s). This was treated with endovascular stenting, with marked improvement in blood pressure levels, stable kidney function and tolerance to restarting the ARB (valsartan).

(A) Serum creatinine, blood pressure and medications over an eight year period in a patient with unilateral atherosclerotic renovascular disease associated with a nonfunctioning kidney (less than 5% by renal scan). This patient developed severe hypertension that responded well to a regiment based upon an angiotensin receptor blocker (valsartan). Several years later, however, she developed worsening renal failure with an eGFR = 16 ml/min/1.73m2, leading to evaluation for kidney transplantation. Her disease was managed conservatively, but she developed severe hypertension and worsening renal function (creatinine above 5.0 mg/dL), leading her physician to withhold the ARB. Serum creatinine fell, although blood pressure was difficult to control and she developed episodes of acute pulmonary edema. (B) Doppler ultrasound identified a stenosis to her remaining functional kidney (peak systolic velocity above 500 cm/s). This was treated with endovascular stenting, with marked improvement in blood pressure levels, stable kidney function and tolerance to restarting the ARB (valsartan).