hypertensive and ischemic nephropaties, renovascular diseases

Zehra Eren, M.D.

• explain hypertansion and renal disease interaction,

• describe renovascular diseases

• describe diagnostic evaluation

• explan therapy in renovascular deseases

• describe and manage renal artery and vein

thrombosis

• explain microvascular renal diseases

Asemptomatic ‘’İncidental Renal Artery Stenosis’’

Renovascular Hypertension

İschemic Nephropathy

Accelerated CV Disease

-Congestive heart failure

-Stroke

-Secondary aldosteronism

Asemptomatic ‘’İncidental Renal Artery Stenosis (RAS)’’

Renovascular Hypertension

İschemic Nephropathy

Accelerated CV Disease

-Congestive heart failure

-Stroke

-Secondary aldosteronism

Some degree of RAS can be identified in 20%-

45% of patients undergoing vascular imaging

Most of these stenoses are of little or no

hemodynamic significance

Asemptomatic ‘’İncidental Renal Artery Stenosis (RAS)’’

Renovascular Hypertension

İschemic Nephropathy Accelerated CV Disease

-Congestive heart failure-Stroke-Secondary aldosteronism

Reduced renal perfusion

Rise in arterial pressure

Diagnosis is established only in retrospect after

succesful reversal of HT with revascularization

3%-5%, F>M

Medial fibroplasia is the most common

Location: midportion of the vessel

Smoking is a risk factor for progression

Most common renovascular lesion (75% - 84%)

Location: origin of artery

Associated with HT, DM, HPL, smoking, abnormal renal function

Asemptomatic ‘’İncidental Renal Artery Stenosis’’

Renovascular Hypertension

İschemic Nephropathy

Accelerated CV Disease

-Congestive heart failure

-Stroke

-Secondary aldosteronism

Establish presence of RAS: location and type of lesion

Establish whether unilateral or bilateral stenosis (or stenosis to a solitary kidney)

Establish presence and function of stenotic and nonstenotic kidneys

Establish hemodynamic severity of renal arteral disease

Plan vascular intervention

Physiologic and functional studies of the Renin-Angiotensin system

-plasma renin levels

-measurement of renal vein renin levels

Noninvasive imaging and assesment of the renal vasculature

-Doppler USG

-radyonuclide imaging

-magnetic resonance arteriography

-computed tomographic angiography

Improved BP

Prevent morbidity and mortality

Preservation of renal function

Medical therapy

Surgical therapy

-angioplasty

-angioplasty and stent replacement

Hemolytic- Uremic Syndrome (HUS)

Thrombotic- Thrombocytopenic Purpura (TTP)

Microangiopathic hemolytic anemia

Thrombocytopenic purpura

Acute renal failure

Fever

Neurologic dysfunction