12May 2019

SONOGRAPHIC FINDINGS IN HYPERTENSIVE PATIENTS SUSPECTED TO HAVE RENAL ARTERY STENOSIS AT MOI TEACHING AND REFERRAL HOSPITAL, ELDORET, KENYA.

  • Resident, Department of Radiology and Imaging, School of Medicine, Moi University, Eldoret, Kenya.
  • Senior Lecturer, Department of Radiology and Imaging, School of Medicine, Moi University, Eldoret, Kenya.
  • Consultant Radiologist and Head of Department, Department of Radiology, Moi Teaching and Referral Hospital, Eldoret, Kenya.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Background: Renal artery stenosis is the leading cause of secondary hypertension. Global prevalence of hypertension is 22% and across the WHO regions it is highest in Africa (30%). Up to 5% (3.5 to 4 million) of all occurrences of hypertension in the United States are caused by renal artery stenosis. The prevalence varies according to the population examined. This prevalence in our region is unknown and the diagnosis is probably missed in many patients. Timely diagnosis is important since renal artery stenosis is a correctable cause of hypertension. Objectives: To describe sonographic findings and determine the prevalence of renal artery stenosis in adult hypertensive patients suspected to have renal artery stenosis at Moi Teaching and Referral Hospital. Methods: This was a cross sectional study done at the ultrasound room in the Department of Radiology and Imaging, Moi Teaching and Referral Hospital, Eldoret between October 2015 and October 2016. Consecutive sampling technique was used on consenting adult hypertensive patients with clinical features suggestive of renal artery stenosis as per the American Heart association Guidelines of 2005 who underwent renal Duplex Doppler ultrasonography. A 3.5- 7 MHz curvilinear phase array transducer of a Philips HD11 XE machine model 2006 was used. All the images were reviewed by two consultant radiologists. Descriptive statistics were summarized for patient socio-demographics. Frequency tables were generated for categorical variables. Inferential statistics were done using Chi-square and Fishers exact tests. Results were presented using tables and charts. Results: The study included 169 participants with a median age of 46 (IQR 30). One hundred and five (62.1%) of them were females. In the findings; Sonographic prevalence of renal artery stenosis was 33.7%. Areas of aliasing was present in 62.5% of those with renal artery stenosis, post stenotic turbulence in 75.4% and thickening and calcification of arterial wall in 3.6%. Tardus- Parvus waveform pattern was seen in 66.1% (on the right) and 64.9% (on the left) in patients with renal artery stenosis. Echogenic kidneys were seen in 25 (43.9%) and loss of cortico medullary differentiation in 15 (26.3%) of the patients with renal artery stenosis. More females (63.2%) had renal artery stenosis than males, and majority, (43.8%) of those with renal artery stenosis were above 55 years. Conclusion: The sonographic prevalence of renal artery stenosis in adult hypertensive patients with specific clinical clues at MTRH was 33.7%. Parvus- Tardus was the commonest waveform pattern seen.

  1. Karasch, T., & Rubin, J. (1998). Diagnosis of renal artery stenosis and renovascular hypertension. European journal of ultrasound, 7, S27-S39.
  2. Derkx, F. H., & Schalekamp, M. A. (1994). Renal artery stenosis and hypertension. The Lancet, 344(8917), 237-239.
  3. Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., Bakal, C. W., Creager, M. A., Halperin, J. L., . . . Puschett, J. B. (2006). ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). Journal of Vascular and Interventional Radiology, 17(9), 1383-1398.
  4. Lubomirova, M., Djerassi, R., Kiperova, B., Boyanov, M., & Christov, V. (2006). Renal Doppler ultrasound in patients with hypertension and metabolic syndrom. Medicinski pregled, 60, 84-86.
  5. Spatola, L., & Andrulli, S. (2016). Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up. Journal of ultrasound, 19(4), 243-250.
  6. Abuagla, E, & Pei, T. (2014). Utility of color doppler ultrasound in the evaluation of renal artery stenosis in comparison with contrast-enhanced magnetic resonance angiography. Saudi Journal of Kidney Diseases and Transplantation, 25(2), 309.
  7. Appel, R. G., Bleyer, A. J., Reavis, S., & Hansen, K. J. (1995). Renovascular disease in older patients beginning renal replacement therapy. Kidney international, 48(1), 171-176.
  8. Olin, J. W., Piedmonte, M. R., Young, J. R., DeAnna, S., Grubb, M., & Childs, M. B. (1995). The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis. Ann Intern Med, 122(11), 833-838.
  9. Strandness, D. E. (1994). Duplex imaging for the detection of renal artery stenosis. American Journal of Kidney Diseases, 24(4), 674-678.
  10. Norris, C. S., Pfeiffer, J. S., Rittgers, S. E., & Barnes, R. W. (1984). Noninvasive evaluation of renal artery stenosis and renovascular resistance: experimental and clinical studies. J Vasc Surg, 1(1), 192-201.
  11. Peng, M., Jiang, X., Dong, H., Zou, Y., Zhang, H., Song, L., . . . Gao, R. (2015). Etiology of renal artery stenosis in 2047 patients: a single-center retrospective analysis during a 15-year period in China. Journal of human hypertension.
  12. Safian, R. D., & Textor, S. C. (2001). Renal-artery stenosis. New England Journal of Medicine, 344(6), 431-442.
  13. Olin, J. W. (2004). Renal artery disease. The Mount Sinai journal of medicine, 71(2), 73.
  14. White, C. J., & Olin, J. W. (2009). Diagnosis and management of atherosclerotic renal artery stenosis: improving patient selection and outcomes. Nature Clinical Practice Cardiovascular Medicine, 6(3), 176-190.
  15. Lao, D., Parasher, P. S., Cho, K. C., & Yeghiazarians, Y. (2011). Atherosclerotic renal artery stenosis?diagnosis and treatment. Paper presented at the Mayo Clinic Proceedings.
  16. Kurtz, A. B., & Hertzberg, B. S. (2004). Ultrasound: the requisites: Mosby Incorporated.
  17. Miralles, M., Cairols, M., Cotillas, J., Gim?nez, A., & Santiso, A. (1996). Value of Doppler parameters in the diagnosis of renal artery stenosis. J Vasc Surg, 23(3), 428-435.
  18. Rumack, C. M., Wilson, S. R., & Charboneau, J. W. (2005). Diagnostic ultrasound vol 1: London: Mosby, 2005.
  19. AbuRahma, A. F., Srivastava, M., Mousa, A. Y., Dearing, D. D., Hass, S. M., Campbell, J. R., . . . Keiffer, T. (2012). Critical analysis of renal duplex ultrasound parameters in detecting significant renal artery stenosis. Journal of vascular surgery, 56(4), 1052-1060. e1051.
  20. Tublin, M. E., Bude, R. O., & Platt, J. F. (2003). The resistive index in renal Doppler sonography: where do we stand? American Journal of Roentgenology, 180(4), 885-892.
  21. Keogan, M. T., Kliewer, M. A., Hertzberg, B. S., DeLong, D. M., Tupler, R. H., & Carroll, B. A. (1996). Renal resistive indexes: variability in Doppler US measurement in a healthy population. Radiology, 199(1), 165-169.
  22. Kim, S., Kim, W., Choi, B., & Kim, C. (1990). Duplex sonography of the native kidney-resistive index vs serum creatinine. J Ultrasound Med, 9, S25.
  23. Platt, J., Ellis, J., & Rubin, J. (1991). Examination of native kidneys with duplex Doppler ultrasound. Paper presented at the Seminars in ultrasound, CT, and MR.
  24. Emamian, S. A., Nielsen, M. B., Pedersen, J. F., & Ytte, L. (1993). Kidney dimensions at sonography: correlation with age, sex, and habitus in 665 adult volunteers. AJR. American journal of roentgenology, 160(1), 83-86.
  25. Musa, M. J. (2014). Evaluation Of Renal Changes for Hypertensive Patients In High Altitude Using Ultrasonography. Sudan University of Science and Technology.
  26. Adedeji, A., Egberongbe, I. I., Adetiloye, V. A., Adeyinka, A. O., Afolabi, O. T., Akintomide, A. O., & Ayoola, O. O. (2010). Evaluation of renal volume by ultrasonography in patients with essential hypertension in Ile-Ife, south western Nigeria.Libyan journal of medicine Vol 5, 2010.
  27. Derkx, F., & Schalekamp, M. (1994). Renal artery stenosis and hypertension. The Lancet, 344(8917), 237-239.
  28. Cochran, W. G. (1965). Sampling Techniques: (2nd Ed): J. Wiley.
  29. Missouris, C. G., Allen, C. M., Balen, F. G., Buckenham, T., Lees, W. R., & MacGregor, G. A. (1996). Non-invasive screening for renal artery stenosis with ultrasound contrast enhancement. Journal of hypertension, 14(4), 519-524.
  30. Harding, M. B., Smith, L. R., Himmelstein, S. I., Harrison, K., Phillips, H. R., Schwab, S. J., . . . Bashore, T. M. (1992). Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization. Journal of the American Society of Nephrology, 2(11), 1608-1616.
  31. House, M. K., Dowling, R. J., King, P., & Gibson, R. N. (1999). Using Doppler sonography to reveal renal artery stenosis: an evaluation of optimal imaging parameters. AJR. American journal of roentgenology, 173(3), 761-765.
  32. Patriquin, H. B., Lafortune, M., J?quier, J.-C., O'Regan, S., Garel, L., Landriault, J., . . . Filiatrault, D. (1992). Stenosis of the renal artery: assessment of slowed systole in the downstream circulation with Doppler sonography. Radiology, 184(2), 479-485.
  33. Stavros, A., Parker, S., Yakes, W., Chantelois, A., Burke, B., Meyers, P., & Schenck, J. (1992). Segmental stenosis of the renal artery: pattern recognition of tardus and parvus abnormalities with duplex sonography. Radiology, 184(2), 487-492.
  34. Carroll, B. A. (1994). Segmental Stenosis of the Renal Artery: Pattern Recognition of Tardus and Parvus Abnormalities with Duplex Sonograph. Investigative radiology, 29(3), 390-391.
  35. Zoller, W., Hermans, H., Bogner, J. R., Hahn, D., & Middeke, M. (1990). Duplexsonography in the diagnosis of renovascular hypertension. Journal of Molecular Medicine, 68(16), 830-834.
  36. Karasch, T., & Rubin, J. (1998). Diagnosis of renal artery stenosis and renovascular hypertension. European journal of ultrasound, 7, S27-S39.
  37. Wachtell, K., Ibsen, H., Olsen, M., Laybourn, C., Christoffersen, J., N?rgaard, H., . . . Lund, J. (1996). Prevalence of renal artery stenosis in patients with peripheral vascular disease and hypertension. Journal of human hypertension, 10(2), 83-85.
  38. Benjamin, M. M., Fazel, P., Filardo, G., Choi, J. W., & Stoler, R. C. (2014). Prevalence of and risk factors of renal artery stenosis in patients with resistant hypertension. The American journal of cardiology, 113(4), 687-690.

[Alungat Omasete M, Abuya Joseph and Kimutai Ezekiel. (2019); SONOGRAPHIC FINDINGS IN HYPERTENSIVE PATIENTS SUSPECTED TO HAVE RENAL ARTERY STENOSIS AT MOI TEACHING AND REFERRAL HOSPITAL, ELDORET, KENYA. Int. J. of Adv. Res. 7 (May). 421-431] (ISSN 2320-5407). www.journalijar.com

Abuya, Joseph Mochama
School of Medicine, Moi University, Kenya, East Africa

DOI:

Article DOI: 10.21474/IJAR01/9055      
DOI URL: http://dx.doi.org/10.21474/IJAR01/9055

Download Full Paper

Download PDF No. of Downloads: 11 | No. of Views: 49