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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a 10-year period, 7200 of 19,000 black hypertensive adults in the University of Cincinnati Medical Center were referred to the Hypertension Service. In selected patients, intravenous urograms (1038) and renal arteriograms (238) were performed; 47 cases of renovascular hypertension (0.65% of the referred group and 0.25% of the entire sample) were identified. Atherosclerosis (32 patients) and fibromuscular dysplasia (11) were the most common causes of renal artery obstruction. Other lesions included traumatic thrombosis (2), Leriche syndrome (1), and postrenal transplant anastomotic thrombosis (1). Twenty-four patients were operated on (6 cured, 14 improved, 4 dead) and 23 treated medically (18 improved, 2 unimproved, 3 dead). Surgical mortality was 0. Follow-up exceeded 5 years in 25 patients. Extrarenal vascular lesions were found in 30 patients and accounted for six of seven deaths. Renal vein renin ratios greater than 1.5:1 (affected to unaffected side) predicted successful surgery in 14 patients, but eight of nine operated patients with ratios less than 1.5:1 also had favorable results. Factors in addition to renin assay were weighed before surgery was recommended. Since renovascular hypertension is rare in adult blacks, intensive investigation for this entity is justified only in patients with distinct suggestive findings. Treatment results in blacks are similar to those in white cohorts.
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PMID:Renovascular hypertension in black patients. 704 Feb 33

The development of chronic renal failure from progressive atherosclerotic renal arterial occlusive disease, termed "ischemic nephropathy," is an important clinical problem in older patients with generalized atherosclerosis obliterans. Studies on the natural history of atherosclerotic renal artery disease have made it possible to identify those patients in whom this disease poses a significant threat to overall renal function. Several factors must be considered in evaluating the renal functional benefit of intervention to relieve arterial obstruction. These include the severity and extent of renal artery obstruction, the level of renal function, renal histopathologic information, and the general medical condition of the patient. Intervention to restore normal renal arterial blood flow is indicated in selected patients to prevent deterioration of renal function that may culminate in the need for dialytic replacement therapy. Percutaneous transluminal angioplasty is the treatment of choice for patients with non-ostial atherosclerotic lesions. Most reports in the literature indicate that surgical revascularization provides more effective long-term therapy for patients with ostial atherosclerotic lesions.
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PMID:Options for therapy of ischemic nephropathy: role of angioplasty and surgery. 872 86

With increasingly accurate non-invasive tests, the clinician frequently discovers obstruction of the renal arteries by atherosclerosis. The decision to reverse this obstruction is not straightforward, particularly when blood pressure can be easily controlled with medications. Proper management of this problem requires knowledge of the accuracy of the diagnosis, the natural history of the disorder, and the outcomes of possible interventions. This review will emphasize the value of a variety of non-invasive tests, the consequences of allowing the arteries to remain obstructed, and the long-term results from reversing renal artery obstruction. Surgical and non-surgical interventions will be examined, including percutaneous angioplasty, angioplasty with wall stenting, surgical atherectomy, and surgical bypass procedures. In contemporary practice hypertension is routinely recognized and aggressively treated regardless of the etiology. Therefore preservation of kidney function is becoming an increasingly important clinical goal. This review will pursue a unified approach to renal artery obstruction and emphasize the goal of preserving glomerular filtration rate.
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PMID:Ischemic disease of the kidney: how and why to consider revascularization. 965 Jan 20

Making the diagnosis of potentially reversible renovascular hypertension can be problematic. Although there are a number of noninvasive screening tests available, no one study is appropriate for every patient. In general, the available tests can be divided into those that identify the functional consequences of a renal artery obstruction (angiotensin-converting enzyme inhibitor-augmented renography) and those that identify the anatomic presence of stenosis (duplex ultrasonography, magnetic resonance angiography, and contrast tomography angiography). The most appropriate diagnostic approach is based largely on the clinical index of suspicion, the potential etiology of the renal artery lesion (fibromuscular dysplasia or atherosclerosis), and the individual patient's physiology and presentation. A potential treatment algorithm is presented.
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PMID:An evidence-based approach to diagnosing renovascular hypertension. 1160 79

Renovascular disease is a common, but complex disorder, the most common causes of which are fibromuscular dysplasia and atherosclerosis. It usually presents in 1 of 3 forms: asymptomatic renal artery stenosis, renovascular hypertension, or ischemic nephropathy. The clinical index of suspicion remains paramount in developing an appropriate diagnostic strategy. Although subject to certain limitations, conventional contrast angiography is usually considered the gold standard in confirming the diagnosis. In addition, there are a number of available non-invasive tests that can aid in decision-making. These tests can be divided into those that detect the anatomic presence of a stenosis and those that identify the functional consequences of the renal artery obstruction. No one study is appropriate for every patient. Treatment options include medical, surgical or percutaneous approaches. Generally, in patients with fibromuscular disease the results of surgery and percutaneous approaches appear superior. In patients with atherosclerotic disease, the data are less consistent, and there does appear to be a group of patients who will respond well to medical management. Potential diagnostic algorithms for diagnosis and treatment are presented in this review.
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PMID:Clinical insights into the diagnosis and management of renovascular disease. An evidence-based review. 1546 12