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2.1
Renovascular Hypertension

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WIKIDATA, Public Domain
WIKIDATA, CC BY-SA 3.0

Presentation

CASE PRESENTATION: A-64-year-old male patient, presented with new-onset malignant hypertension, 13 months after an EVAR operation with CG placement to the left renal artery. [ncbi.nlm.nih.gov]

Evidence for a role in the one-kidney one-clip model of RVHT has been presented but is not clear or definitive. [emedicine.com]

Gastrointestinal

  • Nausea

    One week later, he was readmitted with headache, nausea, vomiting, seizure activity, and hypertension. [ncbi.nlm.nih.gov]

    […] body, such as to the legs, the brain, the eyes and elsewhere Sudden buildup of fluid in the air sacs of the lungs ( pulmonary edema ) If you have a dangerous form of high blood pressure called malignant hypertension, symptoms can include: Bad headache Nausea [nlm.nih.gov]

  • Left Flank Pain

    He initially presented with gross hematuria, left flank pain, and back pain. He was observed in the hospital for 3 days and discharged. One week later, he was readmitted with headache, nausea, vomiting, seizure activity, and hypertension. [ncbi.nlm.nih.gov]

Neurologic

  • Headache

    One week later, he was readmitted with headache, nausea, vomiting, seizure activity, and hypertension. [ncbi.nlm.nih.gov]

    Clinical examination showed headaches (92%), confusion (26%) and vision problems (63%). High blood pressure, and mild to moderate proteinuria were found in all cases. Hypertensive retinopathy was found in 74% of cases. [journals.lww.com]

    During the year in which he was monitored, he had hypertensive emergency associated with headaches. Among the additional tests conducted, laboratory and eye fundus tests and renal ultrasound were normal. [revistanefrologia.com]

    […] in the body, such as to the legs, the brain, the eyes and elsewhere Sudden buildup of fluid in the air sacs of the lungs ( pulmonary edema ) If you have a dangerous form of high blood pressure called malignant hypertension, symptoms can include: Bad headache [nlm.nih.gov]

Workup

If study is technically accurate and Consider percutaneous angioplasty and results are reliable, no further workup If study is technically accurate and stenting. is required. results are reliable, no further workup If accuracy of study is in doubt and [slideshare.net]

Treatment

After interventional treatment, medical treatment using antihypertensive drugs was necessary in 17 of the patients. [ncbi.nlm.nih.gov]

In children with severe hypertension, it may be necessary to initiate medical treatment before a definitive diagnosis is obtained. RVHT is often refractory to medical treatment. [emedicine.medscape.com]

In total, the mean of GFR was not significantly modified after treatment, and averaged 52 mL/min before treatment versus 51 mL/min after treatment. [Table 3] presents the response to treatment in our cases. [sjkdt.org]

Prognosis

With this background, we analyzed clinical and laboratory data and determined mark prognosis survival factors in multivariate analysis by comparing the survival curves by the log-rank test. [journals.lww.com]

Its prognosis is favourable since atheroma or organ lesions are usually lacking. Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. [ncbi.nlm.nih.gov]

[…] renal artery dissection (e.g. from trauma or aortic dissection ) renal infarction Page kidney renal artery embolism or thrombosis EVAR stent graft encircling tumor (e.g. pheochromocytoma ) radiation-induced fibrosis polyarteritis nodosa Treatment and prognosis [radiopaedia.org]

Prognosis of individuals with renovascular hypertension is not easy to determine. Those with atherosclerotic renal artery disease have a high risk of mortality, furthermore those who also have renal dysfunction have a higher mortality risk. [en.wikipedia.org]

Etiology

The importance of considering prenatal as well as postnatal etiologies of acquired renovascular hypertension in neonates is emphasized. [ncbi.nlm.nih.gov]

Renal arterial stent placement was performed in three cases of RAS of an atherosclerosis etiology. [sjkdt.org]

Etiology There are a number of conditions that can cause RVH 1-3 : atherosclerotic renal artery stenosis (~90%) fibromuscular dysplasia (second most common) There are other causes that can cause renal artery obstruction but these are much rarer 2,3 : [radiopaedia.org]

Epidemiology

Epidemiologically, it is found mostly in female patients and is more prevalent in Asian and Latin American countries. Disease may be heterogeneous in presentation. [ncbi.nlm.nih.gov]

Epidemiology [ 3 ] The prevalence of atherosclerotic renal artery stenosis is high - about 7% in individuals older than 65 years and about 50% in patients with diffuse arterial disease, and it is increasingly frequent in an ageing population. [patient.info]

(pg. 780 - 788 ) 39 Prospective evaluation of aggressive medical therapy for atherosclerotic renal artery stenosis, with renal artery stenting reserved for previously injured heart, brain, or kidney, Am J Cardiol, 2006, vol. 96 (pg. 1322 - 1327 ) 40 Epidemiology [eurheartj.oxfordjournals.org]

Pathophysiology

The pathophysiology of renal artery stenosis is reviewed, and the pros and cons of various imaging studies in the appropriate clinical setting are discussed. [ncbi.nlm.nih.gov]

Reorganized to mirror your changing practice, each cardiovascular-problem-based section offers a chapter on pharmacologic treatment (with a minimum of pathophysiology)...a chapter on catheter-based or minimally invasive interventions...and a discussion [books.google.com]

The propensity for angiotensin receptor blockers (ARBs) to affect GFR adversely is based on similar pathophysiology. [emedicine.com]

Prevention

Early diagnosis of renovascular hypertension and timely implementation of appropriate therapeutic procedures ensures optimum control of blood pressure, prevents ischemic nephropathy progression, and prevents the development of cardiovascular morbidity [ncbi.nlm.nih.gov]

Prevention Preventing atherosclerosis may prevent renal artery stenosis. Taking the following steps can help: Lose weight if you are overweight. Ask your provider about your smoking and alcohol use. Control your blood sugar if you have diabetes. [mountsinai.org]

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