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Hyperplasia of the Renal Artery

Renal Artery Hyperplasia


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]
  • Bagla presented early findings showing technical success in 17 of 18 men (94%) who underwent PAE and clinical success in 14 (93%) of the 17 patients. The men ranged in age from 57-81 years.[renalandurologynews.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]
  • Less commonly in intimal and adventitial types, there is focal concentric, long-segment tubular stenosis or diverticular outpouching present (see carotid intimal fibromuscular dysplasia ).[radiopaedia.org]
Pain
  • None suffered any major complications, such as impotence, leaking urine, or infection, none reported post-procedural pain, and none required urinary catheterization.[renalandurologynews.com]
  • Severe stenosis can cause pain in the area of the body that is supplied by the affected artery.[healthcommunities.com]
  • 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]
  • An aneurysm may rupture, resulting in a life-threatening situation Pain or cramping in lower legs (intermittent claudication): FMD that affects the arteries in the legs can cause discomfort or pain when walking and exercising Kidney dysfunction or failure[massgeneral.org]
  • Symptomatic patients commonly present with: hypertension or less commonly renal impairment, due to renal artery stenosis CNS symptoms (e.g. headache, neck pain, pulsatile tinnitus, Horner syndrome ) from transient ischemic attack, stroke, dissection ,[radiopaedia.org]
Fever
  • Imaging differential considerations include: atherosclerosis : usually at origin or proximal portion of artery vasculitis : elevated ESR /- fever present traumatic/iatrogenic vascular injury: correlate with appropriate history segmental arterial mediolysis[radiopaedia.org]
  • Horner's syndrome 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[amboss.com]
  • It is characterized by fever, lymphadenopathy and inflammation of mucous membranes, skin and arteries: mainly coronary, axillary and iliac.[kidneypathology.com]
Falling
  • The study, which is expected to be completed this fall, will follow up patients for two years to assess long-term results.[renalandurologynews.com]
Diarrhea
  • Three of 17 patients reported post-procedural hematospermia, and one of 17 reported transient diarrhea. “The results have been great so far,” Dr. Bagla told Renal & Urology News.[renalandurologynews.com]
  • […] pulsatile tinnitus TIA, amaurosis fugax, stroke, Horner's syndrome Cervical bruit Visceral FMD : Chronic mesenteric ischemia : postprandial abdominal pain, epigastric bruit, weight loss Acute mesenteric ischemia : nausea, vomiting, abdominal pain, bloody diarrhea[amboss.com]
  • There is not diarrhea preceding or during the clinical episode.[kidneypathology.com]
Abdominal Bruit
  • On examination, there was an audible abdominal bruit.[clinical.netforum.healthcare.philips.com]
  • Renal FMD Clinical features of renal artery stenosis Secondary hypertension Abdominal bruit Symptoms of chronic kidney disease Flank or abdominal pain Cerebrovascular FMD Headache, neck pain, pulsatile tinnitus TIA, amaurosis fugax, stroke, Horner's syndrome[amboss.com]
Hypertension
  • This method of treatment of renovascular hypertension is applicable in certain cases, mostly in patients with fibromuscular hyperplasia and in arteriosclerotic renal artery disease.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • Definition / general Hypertension that responds to ACE inhibitors, with stenosis by intravenous pyelogram or renal scans, bruit, elevated renin 2 - 5% of cases of hypertension, surgery curative in 70% Causes Atheromatous plaque : more common in older[pathologyoutlines.com]
Vascular Disease
  • You are more likely to have vascular disease as you get older.[icdlist.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]
  • VASCULAR DISEASE MANAGEMENT 2013:10(5):E86-E88 ______________________________________________ Case Report A 74-year-old female with a long-standing history of uncontrolled hypertension presented for further evaluation.[vasculardiseasemanagement.com]
  • Renal vascular diseases are usually the manifestation of a systemic vascular disease. Here we will focus on renal changes in vascular diseases, and not on extrarenal involvement.[kidneypathology.com]
  • Yet, absence of a bruit does not rule out significant vascular disease. [8] In children, renovascular disease accounts for approximately 10% of all causes of secondary hypertension. [8] Kidney failure is a common presentation in infants and children but[en.wikipedia.org]
Ulcer
  • […] arch syndrome (Medical Encyclopedia) Arterial embolism (Medical Encyclopedia) Arteriogram (Medical Encyclopedia) Cerebral angiography (Medical Encyclopedia) Duplex ultrasound (Medical Encyclopedia) Venous insufficiency (Medical Encyclopedia) Venous ulcers[icdlist.com]
  • Hydrochlorothiazide--acts in the distal convoluted tubule Patient has duodenal ulcer and lost lots of blood and develops prolonged oliguria. Renal biopsy shows epithelial necrosis of tubules, tubulorrhexis, and intratubular casts.[quizlet.com]
Suggestibility
  • NEW ORLEANS—Early findings from the first prospective U.S. trial of prostatic artery embolization (PAE) suggest this approach may be safe and effective for treating lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH), researchers[renalandurologynews.com]
  • These data suggest that blood pressure is not the only determinant of the vascular wall response, and that the effect of a drug on the blood pressure does not necessarily predict the vascular wall response. arteries collagen DNA smooth muscle cells renal[clinsci.org]
  • Doppler ultrasound may be used in both the diagnosis and follow-up of FMD. [1] Children [ edit ] The differentiating presentations are suggestive of FMD being a unique syndrome in respect to the pediatric population.[en.wikipedia.org]
  • A combination of these factors is likely responsible: Genetics: Research suggests that about 10% of cases appear in families.[massgeneral.org]
  • The overall prevalence of the lesion is higher in women, suggesting a possible hormonal influence.[cancerimagingjournal.biomedcentral.com]
Aphasia
  • We can find skin petechiae, purpura, intestinal bleeding, systemic hypertension, and neurological disorders: convulsions, aphasia, visual alterations, coma, and so on. In these cases microangiopathy is more often evidenced in the glomeruli.[kidneypathology.com]
Incontinence
  • This minimally invasive treatment appears to have high success rates with no urologic complications, including impotence or incontinence, they found.[renalandurologynews.com]
  • 切迫性尿失禁 urgency incontinence 切迫性尿失禁 UUI OAB dry 切迫性尿失禁のない過活動膀胱 OAB wet 切迫性尿失禁をともなう過活動膀胱 zygote 接合子 excision 切除 resection 切除 resectoscope 切除鏡 incisional biopsy 切除生検 informed consent 説明と同意 IC seminoma セミノーマ Serratia marcescens セラチア Sertoli cell セルトリ細胞 Sertoli[glossary.urol.or.jp]
Prostatic Disease
  • Diseases Genital Diseases, Male Urological Manifestations Signs and Symptoms[clinicaltrials.gov]
  • disease 前立腺疾患 prostatic neoplasm 前立腺腫瘍 prostatism 前立腺症 prostatosis 前立腺症 prostatic utricle 前立腺小室 prostatic intraepithelial neoplasia 前立腺上皮内腫瘍 PIN prostate biopsy 前立腺生検 prostatovesiculitis 前立腺精嚢炎 prostatovesiculectomy 前立腺精嚢摘除術 prostatolithotomy 前立腺切石術[glossary.urol.or.jp]

Workup

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]
  • This method of treatment of renovascular hypertension is applicable in certain cases, mostly in patients with fibromuscular hyperplasia and in arteriosclerotic renal artery disease.[ncbi.nlm.nih.gov]
  • Following treatment, patients will return for follow-up visits at 1, 6, 12, and 24 months post PAE.[clinicaltrials.gov]
  • 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]
  • Psychosocial treatment: FMD often affects young, otherwise healthy women, and coping with it can be difficult.[massgeneral.org]

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]
  • RENAL INVOLVEMENT IN SYSTEMIC ARTERIAL HYPERTENSION Systemic arterial hypertension (high blood pressure - HBP) has been classified according to etiology in essential, primary or idiopathic (unknown cause) and secondary (caused by other conditions).[kidneypathology.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]
  • 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]
  • Epidemiology of hypertensive kidney disease. Nat Rev Nephrol. 2011;7(1):11-21. [ PubMed link ] Hart PD, Bakris GL. Hypertensive nephropathy: prevention and treatment recommendations.[kidneypathology.com]
Sex distribution
Age distribution

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]
  • ., smoking and fatty diet) fibromuscular dysplasia kidney transplant patients high calcium or phosphorous levels high low-density lipoprotein cholesterol levels Pathophysiology pathophysiology narrowing of artery lumen due to atherosclerosis fibromuscular[medbullets.com]
  • Pathophysiology [ edit ] FMD can be found in almost every artery in the human body, but most often affects the carotid, vertebral, renal arteries and even those that supply the intestines, arms, and the legs. [1] Patients may present with FMD in multiple[en.wikipedia.org]

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]
  • PTRA can also aide in preventing a lifelong dependency on a medication for such a young patient.[en.wikipedia.org]
  • People with FMD may also need to take antiplatelet drugs, such as aspirin, to prevent blood clots Interventional therapy: Physicians may use percutaneous transluminal angioplasty (PTA) to open narrowed sections of arteries.[massgeneral.org]
  • Hypertensive nephropathy: prevention and treatment recommendations. Expert Opin Pharmacother. 2010;11(16):2675-86. [ PubMed link ] Tylicki L, Puttinger H, Rutkowski P, Nieweglowski T, Rutkowski B, Horl WH.[kidneypathology.com]

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