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Fibromuscular Hyperplasia of the Renal Artery
Hyperplasia of the Renal Artery

Presentation

Leading experts from Latin America, Africa, Near and Middle East, Indian Subcontinent, Far East, Oceania and Australia present their expert insights into specific conditions, as well as progress and challenges in the development of the specialty. [books.google.com]

The most accurate diagnosis comes from combining clinical presentation and angiographic imaging. [en.wikipedia.org]

Weakness may be present from hypokalaemia. Headaches and lethargy may also be present. [patient.info]

A bruit may be present over the affected vascular bed, although absence of a bruit does not rule out significant vascular disease. [cathlabdigest.com]

In symptomatic cases, management depends on the presentation, as follows: Presentation with hypertension: The patient should be evaluated by a nephrologist and possibly considered for vascular intervention Presentation as a TIA or ischemic stroke: If [emedicine.medscape.com]

Gastrointestinal

  • Abdominal Bruit

    An abdominal bruit (a rubbing sound heard with a stethoscope placed on the abdomen suggesting a narrowed vessel) along with high blood pressure. Moderate to severely elevated blood pressure, with an onset before age 30 or after age 50. [endovascularwa.com.au]

    Cervical bruit Visceral FMD : Chronic mesenteric ischemia : postprandial abdominal pain, epigastric bruit, weight loss Acute mesenteric ischemia : nausea, vomiting, abdominal pain, bloody diarrhea Splenic infarction : LUQ abdominal pain, fever, nausea [amboss.com]

    On examination, there was an audible abdominal bruit. [clinical.netforum.healthcare.philips.com]

    Noninvasive imaging to screen for renal artery FMD should be considered if one or more of the following is found: Evidence for FMD in any other arterial bed, such as the carotid or vertebral arteries; The presence of an abdominal bruit and hypertension [evtoday.com]

Cardiovascular

  • Hypertension

    […] together with the treatment of hypertension. [cdt.amegroups.com]

    Introduction Clinical definition narrowing of one or both renal arteries this often causes renovascular hypertension grade 1 – RAS (Renal artery stenosis) with no clinical symptoms grade 2 – RAS with controlled hypertension grade 3 – RAS with resistant [medbullets.com]

    Secondary hypertension accounts for approximately 5-10% of all cases of hypertension, with the remaining being primary hypertension. Secondary hypertension has an identifiable cause whereas primary hypertension has no known cause (i.e., idiopathic). [cvphysiology.com]

    Prior to the diagnosis of hypertension, children often report various non-specific symptoms including headache (42%), insomnia (27%), fatigue (26%) and chest or abdominal pain, which may be indicative of hypertension. 8 A minority of children with hypertension [cathlabdigest.com]

    Uncontrolled systemic hypertension, intrarenal hypertension, hyperlipidemia, cigarette smoking, and obesity all may potentially contribute to progressive atherosclerosis. [link.springer.com]

  • Vascular Disease

    You are more likely to have vascular disease as you get older. [icdlist.com]

    Strategies for avoiding vascular disease include eating right, maintaining a desirable weight, quitting smoking, managing stress, and exercising regularly. Resources Periodicals Bloch, M. J., and T. Pickering. [medical-dictionary.thefreedictionary.com]

    Fibromuscular dysplasia (FMD) is an uncommon vascular disease. Patients with FMD have abnormal cellular growth in the walls of their medium and large arteries. This can cause the arteries with the abnormal growth to look beaded. [my.clevelandclinic.org]

    Pohl MA, Novick AC (1985) Natural history of atherosclerotic and fibrous renal artery disease: clinical implications. Am J Kidney Dis 5:A120-A130 Google Scholar 15. Ratliff NB (1985) Renal vascular disease: pathology of large blood vessel disease. [link.springer.com]

    A bruit may be present over the affected vascular bed, although absence of a bruit does not rule out significant vascular disease. [cathlabdigest.com]

Workup

Recognition of these differences is helpful in deciding on the most likely lesion type, appropriate workup and treatment. [link.springer.com]

See Workup for more detail. Management Partly because of the unknown etiology of FMD, no curative therapy exists. Fortunately, FMD is often benign when asymptomatic, and medical treatment is not indicated. [emedicine.medscape.com]

X-Ray

  • Small Kidney

    Ultrasonography of the renal tract - may show asymmetrically sized kidneys or small kidneys. [patient.info]

Treatment

“Patients who have not been helped by surgery or laser treatments have benefited. Since the treatment does not involve placing a catheter or device into the penis, there is no risk of narrowing of the urethra, incontinence or bleeding.” [renalandurologynews.com]

Following treatment, patients will return for follow-up visits at 1, 6, 12, and 24 months post PAE. [clinicaltrials.gov]

[…] together with the treatment of hypertension. [cdt.amegroups.com]

Treatment is now actively pro moted by public health agencies, including the World Health Organization. This is an other case of treatment preceding full understanding of the nature of the disease. [books.google.com]

In another series of 70 patients undergoing treatment for FMD of the cerebral circulation, the mean age at presentation was 62 years. 4 Treatment options for FMD of the renal arteries include medical therapy alone or revascularization by either percutaneous [vasculardiseasemanagement.com]

Prognosis

Prognosis [ edit ] Prognosis and outcome research is scant. In some cases if not managed properly FMD-related aneurysms can occur causing bleeding into the brain, resulting in stroke, permanent nerve damage, or death. [en.wikipedia.org]

[…] allows assessment of end-organ ischemic damage. typical angiographic features include: vascular loops, fusiform vascular ectasia and a string of beads less typical features include: arterial dissection, aneurysm and subarachnoid hemorrhage Treatment and prognosis [radiopaedia.org]

Prognosis Prognosis is good in treated patients with primary hyperaldosteronism. However, patients may continue to be hypertensive and require lifelong antihypertensive therapy. Risk factors for long-term hypertension include older age at diagnosis. [patient.info]

HUS cases in endemic outbreaks have a better prognosis. The severity of systemic hypertension and duration of anuria are also factors related to prognosis. [kidneypathology.com]

and hypernatremia bilateral renal stenosis can lead to volume overload heart failure pulmonary edema Associated conditions other manifestations of atherosclerotic disease carotid artery disease lower extremity artery disease coronary heart disease Prognosis [medbullets.com]

Etiology

[…] dissection Radiation injury : loss of muscle, intense fibrosis in all wall layers; usually after radiation treatment, including renal artery field years previous Takayasu’s aortitis : also called pulseless disease; chronic sclerosing aortitis of unknown etiology [pathologyoutlines.com]

Fibromuscular Dysplasia Fibromuscular Hyperplasia, FMH Submitted by Ab Shrivastava, MD General Considerations Incidence 0.6% via angiography 1.1% via autopsy Female to male ratio 3:1 Presenting age 25-50 Pathology Developmental lesion of unknown etiology [learningradiology.com]

Although the etiology of FMD is unknown, several other associated vascular pathologies have been identified. [emedicine.medscape.com]

In patients with symptoms, percutaneous transluminal angioplasty has emerged as the treatment of choice in most involved vascular beds. 2 Etiology The etiology of FMD is currently unknown, although genetic, hormonal, and mechanical factors have been suggested [cathlabdigest.com]

[…] ses ) an abnormal narrowing or contraction of a body passage or opening; called also arctation, coarctation, and stricture. aortic stenosis obstruction to the outflow of blood from the left ventricle into the aorta; in the majority of adult cases the etiology [medical-dictionary.thefreedictionary.com]

Epidemiology

Epidemiology Age of onset : typically 30–50 years ;, but can manifest at any age Sex : ♀ > ♂ ( 8:1 ) Ethnicity : increased prevalence among the white population References: [1] [2] [3] [4] Epidemiological data refers to the US, unless otherwise specified [amboss.com]

Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology [brainscape.com]

[…] renal arteries this often causes renovascular hypertension grade 1 – RAS (Renal artery stenosis) with no clinical symptoms grade 2 – RAS with controlled hypertension grade 3 – RAS with resistant hypertension, abnormal renal function, or volume overload Epidemiology [medbullets.com]

Although the multiple manifestations of a structural arteriopathy in FMD hint of a genetic cause, such as collagen or elastin mutation, epidemiologic data suggesting familial transmission are generally weak. [emedicine.medscape.com]

Epidemiology Many decades ago the prevalence of primary aldosteronism as a cause of hypertension was thought to be very low - figures like 0.5%-2% had been quoted. [ 1, 2 ] However, it has subsequently emerged that these low prevalence rates were simply [patient.info]

Pathophysiology

Brenner/Rector remains the go-to resource for practicing and training nephrologists and internists who wish to master basic science, pathophysiology, and clinical best practices. [books.google.com]

Pathophysiology Fibromuscular dysplasia (FMD) is an idiopathic, non-inflammatory, non-atherosclerotic, developmental condition that primarily affects small and medium-sized muscular arteries. [amboss.com]

pathophysiology narrowing of artery lumen due to atherosclerosis fibromuscular dysplasia narrowed arteries lead to reduced renal perfusion reduced perfusion leads to activation of renin-angiotensin system increased renin → hypertension, hypokalemia, [medbullets.com]

It is less effective at finding mid-artery or distal-artery disease so this needs to be considered if the underlying pathophysiology is thought to be fibromuscular dysplasia. [clinicaladvisor.com]

The pathophysiologic cause of hypertension in unilateral RAFMD is activation of the renin-angiotensin-aldosterone system (RAAS) secondary to postenotic drop of renal artery pressure and renal ischemia. [cdt.amegroups.com]

Prevention

Reserpine prevents the vascular wall changes on the arterial as well as the venous side of the circulation. On the other hand, captopril although effective in preventing the blood pressure rise does not suppress the hyperplastic response. 4. [clinsci.org]

A few cloves a week cut risk by 32 percent and greater intake decreased risk even more While fruit and vegetable consumption in general helps prevent cancel in this study, garlic yielded the greatest preventive benefit of all the plant foods analyzed. [herbalcuresguide.com]

Prevention Maintaining a heart healthy lifestyle can help to prevent cases of renal arterial stenosis attributable to artherosclerosis. [medical-dictionary.thefreedictionary.com]

PTRA can also aide in preventing a lifelong dependency on a medication for such a young patient. [en.wikipedia.org]

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