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

The case is discussed of a patient with renal insufficiency due to severe stenosis of both ureters brought about by a periaortic inflammatory process. Such periaortitis is seen in severe atherosclerosis; the condition allegedly occurs in 5 to 23% of all patients with an abdominal aortic aneurysm. The literature on this form of retroperitoneal fibrosis is reviewed.
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PMID:[A patient with a wide aorta and 2 wide kidney pelves: retroperitoneal fibrosis]. 186 66

Renal artery occlusive disease, from either atherosclerosis or fibrous dysplasia, may cause hypertension or renal insufficiency. Hypertension results from increased activity of the renin-angiotensin-aldosterone system. There are several ways to evaluate this system as well as several pharmacologic agents that will intervene and modulate the hypertension that results. Percutaneous transluminal angioplasty or surgical revascularization will be necessary in some patients to control blood pressure or improve renal function. Successful evaluation and treatment of these patients are based on clinical experience, an understanding of the natural history of the various disease processes involved, and a comprehensive team approach.
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PMID:Renal artery occlusive disease. 188 92

Although the slow progression of renal insufficiency caused by aging does not usually reach the clinical disease level, nephron loss may be accelerated by the concomitant presence of hypertension and renal artery atherosclerosis. Treatment of hypertension and correction of other risk factors promoting atherosclerosis is appropriate in the elderly. Consideration should be given to a search for reversible causes of renal functional deterioration in elderly patients, particularly in those with increasingly refractory hypertension. In the uncomplicated elderly hypertensive, renal function appears to be adequately preserved if blood pressure is well controlled, although there may be a subset in whom factors other than blood pressure itself, such as glomerular hemodynamic disturbances, promote progressive renal dysfunction.
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PMID:The renally compromised older hypertensive: therapeutic considerations. 199 20

A sixty-two-year-old man who underwent coronary angiography and received acute thrombolytic and anticoagulant therapy for acute myocardial infarction developed multisystemic injury, including renal insufficiency and cutaneous manifestations. Fundoscopic examination and skin biopsy specimen led to the diagnosis of multiple cholesterol embolization syndrome (MCES). Discontinuation of anticoagulants and administration of hemostatic (carbazochrome, tranexamic acid, reptilase, and vitamin K) and antihyperlipidemic (cholestyramine and probucol) drugs resulted in temporary improvement of cutaneous and renal disorders and extended survival for about one year. Besides severe aortic atherosclerosis, postmortem examination revealed numerous cholesterol emboli to multiple organs. MCES is a rare but serious complication of left heart catheterization and anticoagulant therapy, and the optimal treatment remains to be established. The authors suggest here that the above-mentioned therapy might be effective for management of MCES.
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PMID:Management of multiple cholesterol embolization syndrome--a case report. 231 55

Extracorporeal procedures to eliminate LDL from plasma now allow us to drastically lower the plasma LDL-concentrations to virtually every desired level. In a new therapeutic approach the combination of HMG-CoA reductase inhibitors with an LDL/fibrinogen apheresis procedure (the HELP-system) was evaluated in hypercholesterolemic CAD-patients. HELP treatment alone can lower the mean plasma LDL-cholesterol by about 50-60%, HMG-CoA reductase inhibitor therapy reduces the LDL-cholesterol by about 40%. The combination of both treatments resulted in a lowering of mean LDL-cholesterol to about 80% of baseline values. Improvement of blood rheology by lowering plasma viscosity and inhibiting erythrocyte aggregation became apparent. No relevant adverse effects were noted over a period of two years. This therapeutic strategy for maximal LDL-cholesterol lowering may be useful in secondary prevention of coronary heart disease in hypercholesterolemic patients if plasma LDL-C cannot be reduced by diet and drug treatment to desirable plasma levels (LDL-cholesterol less than 120 mg/dl). Preliminary data show an improvement in the symptoms of our CAD-patients treated with this combined therapy. Furthermore, within the near future a combined HELP and dialysis unit will be available for patients with terminal renal insufficiency and progressive atherosclerosis.
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PMID:[Maximal therapy of hypercholesterolemia in coronary heart disease]. 237 8

Lipid abnormalities have been postulated to contribute to renal insufficiency by a mechanism that is analogous to atherogenesis. The majority of patients treated for chronic renal failure die of cardiovascular complications. Lipid abnormalities in this group are thought to contribute to this high mortality. Proving a causal association between dyslipidemia and accelerated atherosclerosis in the end-stage renal disease population has been confounded by the presence of other pro-atherogenic conditions in this population. The current study compiles the lipid data we have accumulated from our renal population for the years 1987 to 1989. The report is divided into three main parts: The first is a survey of lipid levels and atherogenicity indicators in groups with different types of renal disease or modalities of treatment. The second is a multivariate analysis of the relationship of clinical and biochemical variables (and their interactions) to the serum lipid and apolipoprotein levels and their ratios and their change over time in a large dialysis population. In the third study, we quantitate the peritoneal clearances of apolipoproteins A-I and B in patients undergoing continuous ambulatory peritoneal dialysis and assess the relationship of these clearances to serum lipid and lipoprotein levels and risk ratios.
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PMID:Cholesterol and lipid disturbances in renal disease: the natural history of uremic dyslipidemia and the impact of hemodialysis and continuous ambulatory peritoneal dialysis. 248 49

PTA is an established method of revascularization in a variety of medical conditions. It is performed for specific morphologic and clinical indications. PTA is the procedure of choice in Fontaine stage IIB through IV lower extremity ischemia due to iliac and/or femoropopliteal stenosis or short occlusion. Its role is less certain in infrapopliteal disease, although current studies have begun to establish long-term effectiveness. PTA is the procedure of choice for renal revascularization in renovascular hypertension due to fibromuscular disease or non-ostial atherosclerosis, selected cases of renal artery stenosis associated with renal insufficiency, and transplant renal artery stenosis. It is also useful in treating the renovascular component of complex hypertension and may be indicated in severe renal artery stenosis (75%-99%), even in the absence of clinically demonstrable RVHTN. PTA has limited applications in the venous system and only short-term success in the treatment of stenoses in dialysis access fistulas. PTA often serves as an important adjunct to surgical revascularization by providing improved inflow or outflow. PTA is the procedure of choice when anatomically feasible in subclavian steal syndrome. The role of PTA in carotid artery disease, particularly atheromatous disease of the internal carotid artery, is uncertain. The same may be said of PTA for vertebral artery stenosis, although the overwhelming majority of vertebral artery stenoses are morphologically suitable for PTA. PTA and surgery are both effective in the treatment of abdominal angina. There are more data available to verify the long-term patency of thromboendarterectomy and bypass grafts than PTA for mesenteric ischemia. However, since the technical success for PTA is high and since coronary co-morbidity is the most common cause of perioperative mortality in surgical series, PTA should be seriously considered as the procedure of first choice. Serious complications of PTA occur in approximately 5% of cases. Two to three percent of PTA patients have complications requiring surgery or causing a prolongation or alteration of hospital course. The morbidity, mortality, and cost associated with PTA are low. The discomfort is minor, and postprocedural recovery rapid. The major limitations of PTA include its unsuitability for some lesions (long-segment occlusions and stenoses, orifice lesions, eccentric lesions) and postangioplasty restenosis. These problems are being addressed by ongoing laboratory and clinical research. In the near future, it is likely that endoluminal transmural sonography of the vessel wall will help guide our interventions.
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PMID:Noncoronary angioplasty. 252 45

In elderly patients with generalized atherosclerosis and longstanding hypertension, progressive renal insufficiency should suggest renal artery occlusive disease and/or renal cholesterol embolization. Renal cholesterol embolization is not an absolute contraindication to successful surgical revascularization. Renal cholesterol emboli were identified in biopsy specimens obtained in 24 cases at the Cleveland Clinic from 1978 to 1986, and renal artery stenosis was an associated finding in 19. Clinical manifestations of generalized atherosclerosis were common, including ileofemoral atherosclerosis (18), coronary artery disease (16), carotid occlusive disease (15), and carotid occlusive disease with a history of stroke (8). Evidence of embolic events in other organs was common. Hypertension worsened before biopsy in 21 patients with and without renal artery stenosis. Surgery or angiography definitely or probably contributed to renal failure in 16. Of 12 who underwent surgical revascularization of a renal artery, renal function improved in five, remained stable in five, and worsened in one. Renal function improved in the three patients undergoing dialysis before revascularization, and two were able to discontinue dialysis.
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PMID:Atheroembolic renal disease: association with renal arterial stenosis. 252 69

A variety of age-related anatomic and functional alterations in the kidney have been described. Anatomic abnormalities in the aging kidney include a decrease in kidney size, increased glomerular sclerosis, altered tubular structure, and an altered pattern of vascular flow. These anatomic abnormalities are associated with renal functional abnormalities, including decreased renal blood flow, and glomerular filtration rate. Altered renal tubular function, including impaired handling of water, sodium, acid, and glucose, may also be present. Impaired "endocrinologic" functioning manifested by changes in the renin-angiotensin system, vitamin D metabolism, and antidiuretic hormone responsiveness have been reported. The kidney is constantly exposed to the effects of a variety of potentially toxic processes. These range from environmental toxins and drugs, to a variety of chronic medical illnesses including hypertension, diabetes, and atherosclerotic disease. In this context, differentiation of "aging" effects from nephrotoxic effects resulting from these other processes is difficult. It has been argued that hypertension is an important factor in the development and progression of renal insufficiency in the elderly. The relationship between hypertension, glomerular hyperfiltration, atherosclerosis, and progressive renal dysfunction needs further study. Further research may allow the rational recommendation of interventions designed to control age-associated changes in renal function.
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PMID:Renal function in aging. 266 87

This article summarizes our experience with the operative management of renovascular hypertension in a contemporary population of elderly patients. During a recent 18-month period 35 of 74 patients (47%) undergoing an operation for renovascular hypertension at our center were in their seventh (21 patients) or eighth (14 patients) decade of life (mean age, 68 years). There were 17 men and 18 women with blood pressures ranging from 176/90 mm Hg to 280/215 mm Hg (mean, 213/121 mm Hg). Twenty-seven patients (77%) had renal insufficiency (serum creatinine greater than or equal to 1.3 mg/dl). Nineteen patients had severe insufficiency (serum creatinine greater than or equal to 2.0 mg/dl), with five of these patients being dependent on dialysis. Thirty-three of 35 patients (94%) had evidence of organ-specific atherosclerotic damage as manifested by cardiac disease (72%), cerebrovascular disease (37%), or renal insufficiency (77%). Operative management consisted of unilateral revascularization in 17 patients (includes three contralateral nephrectomies), bilateral renal revascularization in 17 patients, and primary nephrectomy in one. Simultaneous aortic replacement was performed in nine patients. There were two operative deaths (5.7%) and two postoperative graft thromboses (4%). Hypertension was cured (three) or improved (27) in 30 of the 33 survivors (91%). Renal function was improved in six and worsened in two patients with severe non-dialysis-dependent renal insufficiency. Three of five patients who were dependent on dialysis before surgery were removed from dialysis after renal revascularization. On follow-up (mean, 10.3 months) we found that five patients had died. This article emphasizes the complexity of atherosclerosis in the current population presenting for operative management of renovascular hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Management of renovascular hypertension in the elderly population. 233 40


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