Renovascular hypertension

Renovascular hypertension

Infobox_Disease
Name = Renovascular hypertension


Caption =
DiseasesDB =
ICD10 = ICD10|I|15|0|i|10
ICD9 = ICD9|403
ICDO =
OMIM =
MedlinePlus = 000204
eMedicineSubj = med
eMedicineTopic = 2006
MeshID = D006978

Renovascular hypertension (or "renal hypertension") is a syndrome which consists of high blood pressure caused by narrowing of the arteries supplying the kidneys (renal artery stenosis). It is a form of secondary hypertension - a form of hypertension whose cause is identifiable.

Diagnosis and presentation

Techniques have been developed to diagnose renal hypertension using digital image processing of radiographs. Treatment may involve angioplasty and stenting of the renal arteries. The syndrome may be related to other diseases of the epithelium.

Suggestive clinical features include onset of hypertension <30 or >50 years of age, abdominal or femoral bruits, hypokalemic alkalosis, moderate to severe retinopathy, acute onset of hypertension or malignant hypertension, and hypertension resistant to medical therapy.

The "gold standard" in diagnosis of renal artery stenosis is conventional arteriography. Magnetic resonance angiography (MRA) is used in many centers, especially among pts with renal insufficiency at higher risk for contrast nephropathy. MRA may overestimate the severity of stenosis relative to angiography. In pts with normal renal function and hypertension, the captopril (or enalaprilat) renogram may be used. Lateralization of renal function [accentuation of the difference between affected and unaffected (or "less affected") sides] is suggestive of significant vascular disease. Test results may be falsely negative in the presence of bilateral disease.

Treatment

Renal hypoperfusion activates renin-angiotensin-aldosterone (RAA) axis; ACE inhibitors and ARB classes of antihypertensives are contraindicated as they might compromise the renal function especially if the Stenosis is bilateral. Nitroprusside, labetalol, or calcium antagonists are generally effective in lowering bp acutely, although inhibitors of the RAA axis [e.g., ACE inhibitors, angiotensin II receptor blockers (ARBs)] are most effective long-term treatment, if disease is not bilateral.

Surgical revascularization appears to be superior for ostial lesions characteristic of atherosclerosis. The relative efficacy of surgery compared with angioplasty (especially with stenting) for fibromuscular dysplasia or for nonocclusive, nonostial atherosclerotic disease is unclear. Angioplasty (with or without stenting) tends to be most effective for mid-vessel or more distal lesions. No studies have adequately compared revascularization with medical therapy. ACE inhibitors or ARBs are ideal agents for hypertension associated with renal artery stenosis, except in pts with bilateral disease (see "Ischemic Nephropathy," below) or disease in a solitary kidney (including an allograft).

ource

* Harrison's Manual of Medicine: Renovascular Disease - Renal Artery Stenosis

ee also

* Hypertensive nephropathy
* Renal artery stenosis
* Renal failure

External links

* [http://www.hmc.psu.edu/healthinfo/r/renovascularhypertension.htm PSU]


Wikimedia Foundation. 2010.

Игры ⚽ Поможем написать курсовую

Look at other dictionaries:

  • renovascular hypertension — hypertension due to occlusive disease of the renal arteries such as renal artery stenosis or fibromuscular dysplasia …   Medical dictionary

  • Hypertension (disambiguation) — Hypertension may refer to the following: * Hypertension without a qualifier usually refers to arterial hypertension (high blood pressure of the arteries) ** Pregnancy induced hypertension is newly diagnosed arterial hypertension in pregnant women …   Wikipedia

  • Hypertension — This article is about arterial hypertension. For other forms of hypertension, see Hypertension (disambiguation). Hypertension Classification and external resources Automated arm blood pressure meter showing arterial hypertension (show …   Wikipedia

  • renovascular — adjective Date: 1961 of, relating to, or involving the blood vessels of the kidneys < renovascular hypertension > …   New Collegiate Dictionary

  • renovascular — Pertaining to the blood vessel s of the kidney, denoting especially disease of these vessels. * * * re·no·vas·cu·lar .rē nō vas kyə lər adj of, relating to, or involving the blood vessels of the kidneys <renovascular hypertension> * * *… …   Medical dictionary

  • hypertension — High blood pressure; transitory or sustained elevation of systemic arterial blood pressure to a level likely to induce cardiovascular damage or other adverse consequences. H. has been arbitrarily defined as a s …   Medical dictionary

  • Pathophysiology of hypertension — A diagram explaining factors affecting arterial pressure The pathophysiology of hypertension is an area of active research, attempting to explain causes of hypertension, which is a chronic disease characterized by elevation of blood pressure.… …   Wikipedia

  • Secondary hypertension — While most forms of hypertension in humans have no known underlying cause (and are thus known as essential hypertension or primary hypertension ), in about 10% of the cases, there is a known cause, and thus the hypertension is secondary… …   Wikipedia

  • Pulmonary hypertension — Pulmonary arterial hypertension Classification and external resources The pulmonary artery receives blood (blue arrow) from the right ventricle of the heart; increased pressure on the artery can impair the function of the right ventricle ICD …   Wikipedia

  • Complications of hypertension — Main complications of persistent high blood pressure Complications of hypertension are clinical outcomes that result from persistent elevation of blood pressure.[1] Hypertension is a risk factor for all …   Wikipedia

Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”