肾动脉狭窄致难治性高血压:1例青少年患者报道及文献回顾

Refractory Hypertension Caused by Renal Artery Stenosis: A Case Report and Literature Review of a Teenage Patient

肾动脉狭窄及肾动脉解剖异常均为青少年高肾素性高血压病的常见病因,两者同时存在临床罕见且仅凭实验室及无创影像学数据难以鉴别两者与高血压病之间的关系。该文报道一例早期出现副肾动脉伴有高醛固酮、未抑制肾素水平性难治性高血压,该患者完善肾动脉造影可见左肾动脉近端重度狭窄,予经皮球囊成形术治疗后高血压明显有所控制,术后肾素、醛固酮可恢复正常范围,最终诊断为肾动脉狭窄引起的高血压。因此,建议在临床实践中,青少年继发性高血压排查中对肾动脉狭窄、主动脉畸形及先天性狭窄应予充分重视及尽早评估,以使患者得到及时有效救治。Renal artery stenosis and renal artery anatomical abnormalities are common causes of adolescent high renin hypertension, and their coexistence is rare in clinical practice. It is difficult to distinguish the relationship between the two and hypertension based solely on laboratory and non-invasive imaging data. This article reports a case of early onset of refractory hypertension with high aldosterone and unrestricted renin levels in the accessory renal artery. The patient’s complete renal angiography showed severe stenosis in the proximal left renal artery. After percutaneous balloon angioplasty, the hypertension was significantly controlled, and renin and aldosterone levels returned to normal after surgery. The final diagnosis was hypertension caused by renal artery stenosis. Therefore, it is recommended that in clinical practice, renal artery stenosis, aortic malformation, and congenital stenosis should be fully valued and evaluated as early as possible in the screening of secondary hypertension in adolescents, so that patients can receive timely and effective treatment.