Ureteropelvic Junction Obstruction by an Accessory Renal Artery: An Under-recognized but Reversible Cause of Renovascular Hypertension

An unusual case of a 41-year-old woman with renovascular hypertension associated with unilateral hydronephrosis and ureteropelvic junction obstruction (UPJO) due to an accessory renal artery crossing the ureter were reported. Following surgical correction of the UPJO by dismembered pyeloplasty, the patient’s hydronephrosis resolved, and her requirement for antihypertensive therapy substantially decreased. Our case demonstrates that acquired UPJO due to an accessory renal artery was an important but under recognized cause of renovascular hypertension. In cases of UPJO presenting with hypertension, renal impairment, recurrent urinary tract infection, recurrent stones, or debilitating pain, surgical intervention may be considered. Clinicians should consider UPJO in the differential diagnosis for secondary hypertension, particularly among patients in whom physical exam, laboratory findings, and renal ultrasound with Doppler are unrevealing.