Tuesday, January 5, 2010

Renovascular Hypertension


Renal hypertension is high blood pressure due to narrowing of the arteries that carry blood to the kidneys, is a form of what is called secondary hypertension, which is hypertension caused by another condition in the body.Renovascular disease is one of the most common causes of curable hypertension but accounts for < 2% of all cases of hypertension.
Renovascular hypertension a high blood pressure caused by decreased blood flow to the kidneys
Its occurs more often in white men and blacks of both sexes. It occurs in approximately 10 out of 100,000 people. Age of onset depends upon the cause of damage to the kidney blood vessels. It often occurs in men over the age of 45 with atherosclerosis, and in women under the age of 45 with fibromuscular dysplasia. Around 10% of children with fibromuscular dysplasia also develop renovascular hypertension.
Renal  hypertension denotes the causal relationship between anatomically evident arterial occlusive disease and elevated blood pressure. When the arteries that carry blood to your kidneys become narrow because of atherosclerosis, which causes plaque deposits to collect in the renal artery, and fibromuscular dysplasia, in which cells from the artery wall overgrow and narrow the artery, less blood flows to the kidneys. The kidneys mistakenly respond as if your blood pressure is low and give off hormones that tell the body to hold on to more salt and water.
arteries supplying the kidneys renal artery stenosis
The response, the kidney produces a protein called renin. When renin is released into the bloodstream, it ends up being converted into an enzyme that makes the body retain sodium (salt) and constricts the arterioles, which causes the symptoms of renovascular hypertension. This causes your blood pressure to rise.
When renovascular hypertension is caused by a blood clot in a renal artery, the patient will usually have a sudden pain in the side and bloody urine.  Renovascular hypertension can lead to many serious complications, including hypertensive heart disease, stroke, blindness, myocardial infarction, congestive heart failure, blood vessel damage, kidney damage, and kidney failure. Techniques have been developed todiagnose 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.
High blood pressure caused by narrowing of the arteries that lead to the kidneys (renovascular hypertension) is often difficult to control. There are a variety of high blood pressure medications available. Nitroprusside, labetalol, or calcium antagonists  are generally effective in lowering blood pressure 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.
Percutaneous transluminal angioplasty (PTA) is recommended for most patients, including younger patients with fibromuscular dysplasia of the renal artery. Cure rate is 90% in appropriately selected patients; surgical mortality rate is <  1%. Medical treatmentis always preferable to nephrectomy in young patients whose kidneys cannot be revascularized for technical reasons.
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