Renovascular hypertension

Renovascular hypertension. It is high blood pressure due to narrowing of the arteries that carry blood to the kidneys . This condition is also called renal arterial stenosis.

Summary

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  • 1 Description
  • 2 Risk factors
  • 3 Causes
  • 4 Symptoms
  • 5 Diagnosis
    • 1 Hematological:
    • 2 Radiological
  • 6 Treatment
    • 1 Prevention
    • 2 Medications
    • 3 Surgical procedures
  • 7 Complications
  • 8 Sources

Description

Renovascular hypertension is high blood pressure that is caused by the narrowing (stenosis) of one or both renal arteries, which supply the kidneys with blood. Narrowing of the renal arteries reduces blood flow to the kidneys. This is a potentially serious condition that requires care from your doctor. Each kidney is capable of regulating the body’s blood pressure to ensure that each organ has an adequate supply of oxygenated blood. This happens by activating a cascade of hormones known as the renin-angiotensin system .

Renal artery stenosis triggers the release of these hormones, which later becomes a cause of hypertension (high blood pressure). Since hypertension is a major cause of strokes and heart attacks, it is a serious condition that requires diagnosis and treatment.

Risk factor’s

The following factors increase your chances of developing atherosclerosis or fibromuscular dysplasia, which are the main causes of renovascular hypertension.

  • Smoking
  • Obesity
  • Advanced age
  • High cholesterol
  • Diabetes
  • Family or personal history of cardiovascular disease
  • Family or personal history of fibromuscular dysplasia

Causes

There are many diseases that can cause narrowing of the renal arteries. The two most common causes are atherosclerosis and fibromuscular dysplasia.

  • Atherosclerosis: Often called “hardening of the arteries,” it is the result of fatty plaque in the arteries and blocks the flow of blood to the kidneys. Mainly occurs in men over 50.
  • Fibromuscular dysplasia– an inherited disorder in which the muscle and fibrous tissue of the wall of the renal artery thicken and harden into rings that block blood flow to the kidneys. It occurs mainly in young women between the ages of 30 and 40.

Symptoms

People with renovascular hypertension may have a history of high blood pressure that is severe and difficult to control with medication.

Symptoms of renovascular hypertension:

  • High blood pressure at an early age.
  • High blood pressure that suddenly gets worse or is difficult to control.
  • Kidneys that are not working well, which often happens suddenly.
  • Narrowing of other arteries in the body, such as those to the legs, brain, eyes, and elsewhere.
  • A “wheezing” sound in the abdomen, heard with a stethoscope
  • Heart failure episodes
  • Sudden accumulation of fluid in the alveoli of the lungs (pulmonary edema).

If you have a severe headache, nausea or vomiting, confusion, vision changes, or nosebleeds, you can have a serious and dangerous form of high blood pressure called malignant hypertension .

Diagnosis

The diagnosis is based on the elements of the interrogation and the physical examination, as well as on the results of the complementary studies that may be hematological and radiological.

Hematological:

  • Cholesterol level.
  • Renin and aldosterone levels.
  • Blood urea nitrogen test.
  • Blood creatinine test.
  • Blood potassium test.
  • Creatinine clearance.

Radiological

  • Renal arteriography— dye is injected into the arteries of the kidney and an x-ray is taken of them
  • Doppler ultrasound— a procedure that uses sound waves to examine various parts of the body
  • Magnetic resonance angiography— produces highly detailed two-dimensional and three-dimensional images of blood vessels using radio waves in a strong magnetic field instead of using X-rays
  • Angiotensin-converting enzyme(ACE) inhibition renography : a non-invasive imaging procedure that examines the presence of renovascular hypertension and renal arterial stenosis
  • Computed tomography angiography: A procedure that uses high-resolution computed tomography (CT) images and contrast media injected into the veins to produce an accurate image of the renal arteries. This procedure is rapidly replacing renal arteriography.

Treatment

High blood pressure caused by narrowing of the arteries leading to the kidneys (renovascular hypertension) is often difficult to control. Therapeutic options include:

Prevention

Preventing atherosclerosis or hardening of the arteries can prevent the development of renal artery stenosis. You can do this by following these tips:

  • Lose weight if you are overweight.
  • Ask your doctor about smoking and alcohol consumption.
  • Check your blood glucose if you have diabetes.
  • Verify that your doctor is monitoring blood cholesterol levels.
  • Eat a heart-healthy diet.
  • Get regular exercise.

Medicines

Medications will initially be prescribed to help control blood pressure. Since the response to medications varies, your doctor will check your blood pressure frequently and can adjust the type, combination, or dose of medications. Some types of high blood pressure medications (antihypertensives) include the following:

  • Diuretics
  • Beta-blockers
  • Calcium channel blockers
  • ACE inhibitors (except in cases where both renal arteries are blocked)
  • Angiotensin receptor blockers
  • Alpha Blockers
  • Vasodilators

Surgical procedures

If you have uncontrolled, acute renovascular hypertension, your doctor may suggest interventions to restore blood flow to the kidneys. Some types of interventions include the following:

  • Revascularization: A vascular surgeon will perform a major operation that creates a new path for blood to flow to the kidneys by connecting one of your veins, or a tube, over and below the blocked area.
  • Angioplasty: A less invasive method in which a catheter with a balloon tip is inserted into the blocked artery. The balloon is rapidly inflated and deflated to open the artery to allow blood flow. Your doctor may insert a small metal mesh tube, called a stent, into the artery to help keep it open.
  • Endarterectomy: Another type of major surgery where the inner layer of the renal artery containing the plaque is removed.

Complications

If your blood pressure is not well controlled, you are at risk of the following complications:

  • Aortic aneurysm .
  • Heart attack .
  • Heart failure .
  • Chronic kidney disease.
  • Stroke .
  • Vision problems
  • Poor circulation to the legs

 

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