PP066. Renal artery stenosis revealed by an early-onset preeclampsia: A series of 6 cases

Abstract

Introduction: Renovascular hypertension (HT) due to an renal artery stenosis (RAS) is uncommon. Therefore, it is actually very rare to diagnose RAS during a pregnancy; very few cases have been published.

Objectives: We report here a series of RAS diagnosed after an early-onset preeclampsia (EOPE).

Methods: We reviewed the files of women who had been seen at our Obstetric Medicine Clinic after an EOPE over a 19-year period. EOPE was defined by occurrence of proteinuria ⩾0.30g/d before 32 weeks of gestation (WG) with permanent HT ⩾ 140mmHg for systolic pressure and/or 90 for diastolic pressure.

Results: Six cases of RAS complicated with EOPE were included in the study (see table). Mean age at the time of EOPE was 27.8 years (24-35), mean term of appearance of EOPE was 22.8 WG (10-31) and mean parity was 1.5 (1-3). HELLP syndrome was found in one case, no patient had renal failure. Fetal death had occurred in three cases (two medical terminations of the pregnancy and one in utero fetal death). The mean birth weight of surviving neonates was 1235g (1070-1410). Physical examination revealed an abdominal bruit in two cases. RAS was suggested with duplex sonography in two cases, and evidenced with conventional percutaneous contrast angiography in five cases. RAS was secondary to a fibromuscular dysplasia in five cases and to atheromatosis in one case. Angioplasty was performed during conventional angiography procedure in four cases. During the follow-up, two women had a subsequent uneventful pregnancy. Restenosis was diagnosed in one case five years after angioplasty. PE: Pre-eclampsia. WG : Weeks of Gestation. MTP: Medical Termination of Pregnancy. IUFD : Intra-Uterine Fetal Death. RAS : Renal Artery Stenosis. NA : Not Applicable

Conclusion: This series shows the necessity of exploring every case of HT with clinical features suggestive of secondary HT. Moreover, after an adverse obstetrical event, mainly after an EOPE and namely if it had occurred very early (before 28 WG), renovascular HT must be excluded before a subsequent pregnancy. Doppler ultrasound of the renal arteries is the first imaging modality to use since it is simple and noninvasive. Magnetic resonance angiography or computed axial tomography are also convenient. However, conventional percutaneous contrast angiography remains the gold standard for diagnosis of RAS, since it shows directly renal arteries and allows intervention in the same time with angioplasty and/or stent placement.