Renal Artery Dilatation in a Patient on Captopril: Changing a ‘Two-Kidney, Two-Clip Hypertension’ into a ‘Two-Kidney, One-Clip Hypertension’

In this paper we report on a patient with accelerated hypertension associated with a totally obstructed right renal artery and a severe constricted left one. In this ‘two-kidney, two-clip’ model of renovascular hypertension, captopril in combination with severe sodium restriction was not effective, possibly as a consequence of overloading with sodium and water due to a low renal perfusion pressure at the left side. Transluminal renal artery dilatation changed this ‘two-kidney, two-clip’ into a ‘two-kidney, one-clip’ model of renovascular hypertension, which subsequently responded well to captopril treatment. Some pathophysiological mechanisms involved are briefly discussed.