Renal Vein Renin Sampling

Renal vein renin (RVR) sampling can help determine whether renal artery stenosis is a significant contributor to a patient’s hypertension. It can also help determine which patients with renal vascular hypertension (RVH) may benefit from revascularization by percutaneous or surgical methods.

Indications

To determine which patients with RVH may benefit from revascularization by percutaneous or surgical methods
To determine the physiologic significance of an anatomic stenosis that is of indeterminate grade
To assess whether a tumor secretes renin

Contraindications

Patients who are not candidates for revascularization by any means
Patients without access to the renal veins because of venous occlusion or anatomic abnormalities
Severe uncorrectable coagulopathy

Equipment

Catheter

4F or 5F Cobra catheter (various manufacturers) with a side hole close to the distal tip
Alternatively, a Simmons catheter (various manufacturers) or other angled catheter may be a better fit for a particular patient’s anatomy
Rarely, a coaxial microcatheter system is necessary to obtain a stable position in a segmental renal vein for segmental sampling (various manufacturers)

Guidewire

Bentson (various manufacturers)
Rosen (Cook Medical, Bloomington, INI)
Angled Glidewire (Terumo Medical Corp., Somerset, NJ)
Wire for microcatheter system (various manufacturers)

Technique

Anatomy and Approach

The renal veins lie ventral to the renal arteries. The left is longer than the right and passes in front of the aorta, just inferior to the origin of the superior mesenteric artery. The renal veins enter the vena cava around the level of L1-L2. The left renal vein is usually slightly more cephalad than the right. It receives drainage from the left gonadal, left inferior phrenic, and left adrenal veins.

Renal vein anomalies are common. Multiple renal veins can arise from one or both kidneys; there can be circumaortic or retroaortic left renal veins, and rarely the renal veins can arise from the iliac vessels.

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