Renal artery stenosis complicating polycystic kidney disease

Polycystic kidney disease (PCKD) commonly causes hypertension and leads to chronic renal insufficiency. Correctable renal artery stensosis can coexist with PCKD and contribute to both hypertension and progressive decline in renal function but is often overlooked. To illustrate the diagnostic and therapeutic implications of this unusual combination of pathology, the authors present the case of a 59-year-old woman with severe PCKD who presented with recurrent bouts of malignant hypertension, flash pulmonary edema, and accelerated decline of renal function over a 3-month period. In the course of normal findings from cardiac catheterization, aortography demonstrated severe right renal artery stenosis. Captopril renal scintigraphy confirmed the viability of both kidneys and the physiologic significance of the right renal artery stenosis even in the setting of chronic renal insufficiency. Right renal artery revascularization was achieved by using a hepatorenal bypass with reversed greater saphenous vein. The pa...