Details Descriptions About :: Renovascular Hypertension

 Renovascular hypertension is a rise in systemic blood pressure resulting from stenosis of the major renal arteries or their branches or from intrarenal atherosclerosis. The narrowing or sclerosis may be partial or complete, and the resulting blood pressure elevation may be benign or malignant. Approximately 5% to 10% of patients with high blood pressure display renovascular hypertension. Age Alert Renovascular hypertension is most common in persons under age 30 or over age 50.

Causes for Renovascular Hypertension

Causes In 95% of all patients with renovascular hypertension Atherosclerosis (especially in older men) Fibromuscular diseases of the renal artery wall layers, such as medial fibroplasia and, less commonly, intimal or subadventitial fibroplasia Other causes Arteritis Anomalies of renal arteries Embolism Trauma Tumor Dissecting aneurysm

Pathophysiology Renovascular Hypertension

Pathophysiology Stenosis or occlusion of the renal artery stimulates the affected kidney to release the enzyme renin, which converts the plasma protein angiotensinogen to angiotensin I. As angiotensin I circulates through the lungs and liver, it’s converted to angiotensin II, which causes peripheral vasoconstriction, increased arterial pressure and aldosterone secretion and, eventually, hypertension.

Signs and symptoms Renovascular Hypertension

Signs and symptoms Elevated systemic blood pressure Headache, light-headedness Palpitations, tachycardia Anxiety, mental sluggishness Decreased tolerance of temperature extremes Retinopathy Significant complications: heart failure, myocardial infarction, stroke, renal failure

Diagnostic Lab Test results

Diagnostic test results Renal scan testing that includes administration of an angiotensin-converting enzyme inhibitor such as captopril, renal angiography, and renal ultrasound with Doppler evaluation shows evidence of renal stenosis. Excretory urography shows slow uptake in one or both kidneys. Complete blood count reveals anemia. Blood chemistries show abnormal electrolyte levels and elevated blood urea nitrogen and creatinine.

Treatment for Renovascular Hypertension

Treatment Symptomatic measures: antihypertensives, diuretics, sodium-restricted diet Balloon catheter renal artery dilation in selected cases to correct renal artery stenosis without risks and morbidity of surgery Insertion of renal artery stents Surgery to restore adequate circulation and to control severe hypertension or severely impaired renal function: renal artery bypass, endarterectomy, arterioplasty as a last resort, nephrectomy

 

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