Montgomery et al evaluated patients with the onset of hypertension following trauma. In many of these patients occult renovascular traumatic injury is the cause. The authors are from the University of Louisville.
Features:
(1) history of significant trauma with multiple injuries, typically from an automobile or motorcycle accident
(2) no compelling clinical reasons to suspect renal trauma during acute trauma resuscitation
(3) no history of hypertension prior to injury
(4) onset of sustained hypertension 2 to 32 weeks after trauma
(5) elevated renin in the renal vein of the affected kidney
Angiographic findings:
(1) laceration of the renal artery or a major branch
(2) constriction of a renal artery secondary to scarring
Management:
(1) antihypertensive medications and salt restriction may be sufficient
(2) revascularization of the kidney may be required
(3) nephrectomy may be necessary if the injury is severe enough or if blood pressure cannot be controlled otherwise
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