Hi... I recently had an MRA (Magnetic Resonance Angiogram, an MRI with Gadolinium based dye injected to highlight arteries) and just today got the expected results... I have a "severe stenosis at the origin of the right renal artery". The symptoms that started the path to this diagnosis was rapid onset, very high blood pressure (220/135) which was followed by a renal ultrasound that demonstrated a small right kidney... Rapid onset high blood pressure and a small kidney often indicates Renal Artery Stenosis.

The blood pressure is controlled today as it has been for some time... The left kidney function appears to be good... The right kidney has some function though how much is not clear. I am about to do a differential renal function scan which I was told is a radioactive tracer dye inject via IV into the arm with subsequent monitoring with a Geiger counter type device over each kidney to determine how much of the material passes through which kidney or something like that... It would appear that whatever that shows, the nephrologist still wants me to go do angioplasty to attempt to open the artery and leave behind a metal stent...

Now here is my big question. The Iodine dyes they use for highlighting the arteries in this angioplasty procedure are TOXIC to the KIDNEYS and can bring about RENAL FAILURE!!!! Now, I am struggling with that... I am already struggling with one bad kidney and they want me to put the other one at risk???!!!!

Now, years ago I had a Cat scan of another body area and I had a contrast dye injected then. I am assuming that too was Iodine (10 years ago) and I had no problem with that... Would that be an indicator that I could handle iodine again or is this different because I now have one marginal kidney and one (the good one) that is only now recovering from getting blasted by very high blood pressure back in August?? My creatinine is just now back in the normal range (1.2 mg/dL now) although it was never horribly high with 1.5 mg/dL being the highest it got.

And has anyone heard of using alternate dyes for this procedure?? One x-ray tech told me he believes they can also use a gadolinium based dye similar to what I had in my recent MRA?? That I haven't seen mentioned anywhere on the web so likely that information was bogus...

Does anyone have any knowledge about the likelihood of bringing on kidney failure of my good kidney while trying to save the other one due to a reaction to these Iodine based dyes?? Any help would be much appreciated...

thanks... diitto....

Hi... I recently had an MRA (Magnetic Resonance Angiogram, an MRI with Gadolinium based dye injected to highlight arteries) and just today got the expected results... I have a "severe stenosis at the origin of the right renal artery". The symptoms that started the path to this diagnosis was rapid onset, very high blood pressure (220/135) which was followed by a renal ultrasound that demonstrated a small right kidney... Rapid onset high blood pressure and a small kidney often indicates Renal Artery Stenosis.

The blood pressure is controlled today as it has been for some time... The left kidney function appears to be good... The right kidney has some function though how much is not clear. I am about to do a differential renal function scan which I was told is a radioactive tracer dye inject via IV into the arm with subsequent monitoring with a Geiger counter type device over each kidney to determine how much of the material passes through which kidney or something like that... It would appear that whatever that shows, the nephrologist still wants me to go do angioplasty to attempt to open the artery and leave behind a metal stent...

Now here is my big question. The Iodine dyes they use for highlighting the arteries in this angioplasty procedure are TOXIC to the KIDNEYS and can bring about RENAL FAILURE!!!! Now, I am struggling with that... I am already struggling with one bad kidney and they want me to put the other one at risk???!!!!

Now, years ago I had a Cat scan of another body area and I had a contrast dye injected then. I am assuming that too was Iodine (10 years ago) and I had no problem with that... Would that be an indicator that I could handle iodine again or is this different because I now have one marginal kidney and one (the good one) that is only now recovering from getting blasted by very high blood pressure back in August?? My creatinine is just now back in the normal range (1.2 mg/dL now) although it was never horribly high with 1.5 mg/dL being the highest it got.

And has anyone heard of using alternate dyes for this procedure?? One x-ray tech told me he believes they can also use a gadolinium based dye similar to what I had in my recent MRA?? That I haven't seen mentioned anywhere on the web so likely that information was bogus...

Does anyone have any knowledge about the likelihood of bringing on kidney failure of my good kidney while trying to save the other one due to a reaction to these Iodine based dyes?? Any help would be much appreciated...

thanks... diitto....
don't let them give you the MRI dye, it contains gadolinium. if you have any level of renal insufficiency when receive an MRI w/ contrast, you are at risk for developing Nephrogenic Systemic Fibrosis - an incurable disease for which there is presently no known effective treatment.

don't let them give you the MRI dye, it contains gadolinium. if you have any level of renal insufficiency when receive an MRI w/ contrast, you are at risk for developing Nephrogenic Systemic Fibrosis - an incurable disease for which there is presently no known effective treatment.

My mother had an angiogram and had a cypher stent placed in her right artery which was 95% blocked. She developed a severe rash the next day where she looked sunburned, especially on her back, ankles, wrists, and inside of fingers- the "hotspots" I would say. She had itching and they gave her benadryl. It took almost 2 weeks for it to go away. She was also on steriods for the last 3 days of her hospital stay. She peeled from her neck to her toes. Nothing on her face. I've read about NSF and am concerned that if it had that much affect on her outside - what happened to her inside? Doctors never did 'pinpoint' what caused the reaction. I read that it could be the med on the stent, the polymer on the stent, the dye, and plavix - any one of them could cause this reaction.

She is fine now, but like I said, what happened inside I don't know. Her fingernail beds are indented now and they never used to be.

I am not sure what types of dyes they use in the tests you are about to have. I have kidney disease with reduced kidney function and had angiograms done. The reason they always run blood and urine tests before the procedure is to determine the level of kidney function. If it is reasonably good, they use a cheaper dye. If reduced, they use a costly dye that is not as harsh on the kidneys. There is a risk or renal failure from the use of dyes, as you know. I guess the risk of damage to the kidneys rises with decline in kidney function.

I also wanted to let you know that they took extra precautions due to her kidney disease. They gave her lots of intravenous fluids before and after to help flush the kidneys.

Diitto,
I just wanted to let you know that I've been living with renal artery stenosis and one small, only slightly functioning kidney, since 1977. My blood pressure has been well controlled with calcium channel blockers, and I never had surgery. The nephrologist who diagnosed me told me that I needed emergency bypass surgery, and that if I didn't have it, I'd be on dialysis within a few months.

Thank God, I decided to get a second opinion. The second nephrologist felt we should manage the blood pressure with medications and not rush to do surgery, since the stenosis was on the side of the normally functioning kidney, and if the bypass didn't take, I'd be out of luck. Fast-forward 31 years...I never had the surgery, never even had a stent put in, my blood pressure has been well managed with calcium channel blockers, and my kidney function (despite 22 years of diabetes) is still near 93%!!!

So, make certain you get a few opinions before doing anything drastic. Best of luck.

Ruth

Sam,

What a great post! Thank you so much for sharing your experience with others. I am so glad you didn't listen to the doctor all those years ago and got a second opinion. I like happy endings...good for you! :)

Sam...
Im glad it turned out this way for you. My son MAY be facing this diagnoises...& it puts my mind at ease...(a bit) ;)

I was extremely lucky in that when I went to get a second opinion, I went to the Assistant Chief of Nephrology at Boston's Brigham & Women's hospital. This man was one of the best doctors I've ever had the pleasure of working with. Also, he introduced himself by his first and last name, NOT as "dr.....x", and we were immediately on a first name basis with each other. I absolutely hate it when doctors use your first name, but expect you to use their title.


Mike gave me two of the best pieces of advice anyone could ever get in regards to dealing with all doctors. The first was that a good doctor could and should tell you ALL your possible options, and the risks and benefits of each, and should also give his/her opinion as to which is the best option, but that it is YOUR body, and no one else can tell you which risks are more/less scary for YOU! The decision should be mutually arrived at between the doctor and the patient, not just an order given by a doctor who hardly knows you.

Second, he also said that it doesn't matter how great a doctor's reputation is...if that doctor can't explain things to you in language you can understand, then he isn't the right doctor for you!

A lot of years have passed since I first met Mike, and since then I've had to deal with a heart attack, SVT, fibromyalgia, GERD and Barrett's esophagitis, and two different types of cancer, and carpal tunnel and Dupuytren's syndrome. The advice Mike gave me has empowered me in all my dealings with the medical community. Luckily, my PCP was a student of Mike's and has the same attitude, and most of my doctors are similar. On the rare occasion that I've encountered a doctor who wanted to play God while belittling my intelligence, I voted with my feet....and found another doctor.l

Ruth

Ruth,

what a great post! Thank you for sharing your thoughts. Sometimes it takes a lifetime of experiences to gain enough knowledge to deal with the medical establishment efficiently and make it work to our advantage.
I am sorry you've had to face so many setbacks. I admire you for overcoming these obstacles and keeping a positive attitude. You are very lucky to have been under the care of such knowledgable and compassionate doctors. Surely that has made a difference also. I hope you're doing fine now. :)

flowergirl