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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report 2 patients with severe renal failure and hypertension secondary to atherosclerotic renovascular disease who required hemodialysis. Successful surgical revascularization in these patients resulted in the recovery of renal function (twice in a patient) and in controlling the blood pressure. These results indicate that in the presence of severe renal artery obstruction renal parenchyma may be preserved, while renal function is absent. We highlight the usefulness of preoperative renal arteriography for evaluation of the affected vessel and the demonstration of collateral circulation and the value of preoperative renal biopsy in the prediction of the viability of the kidney parenchyma.
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PMID:Reversal of renal failure after revascularization in atheromatous renovascular disease. Report of two cases. 321 63

An analysis of the plasma renin levels in relation to the incidence of severe cardiovascular complications (coronary thrombosis, stroke, ruptured aortic aneurysm) was made in 325 patients with various types of hypertension. These patients had one to four measurements of plasma renin activity taken under standard conditions of sodium intake and posture in the period 1963-68. The follow-up was 5 to 10 years in the four groups of hypertensive patients (essential hypertension, malignant hypertension, hypertension secondary to renal parenchymatous disease and hypertension caused by, or associated with, renal artery obstruction). For all 325 patients, the incidence of such complications was 23.6, 20.4 and 44.7% in the low, normal and high renin groups. These findings are at variance with the claim that renin constitutes a serious risk factor in hypertensive patients, especially if it is isolated from other parameters such as the level of diastolic pressure, the adequacy of kidney function, the effectiveness of dietary and drug management of hypertension, and especially the presence or absence of atherosclerotic lesions of the large vessels at the time of the renin determination.
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PMID:Renin in hypertension: how important as a risk factor? 435 35

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.
Hypertension
PMID:Renovascular hypertension in black patients. 704 Feb 33

Renovascular hypertension is defined as a kind of hypertension secondary to altered renal perfusion with the activation of the renin-angiotensin system. Since a large number of these patients benefits from treatment--be it medical, surgical or angioplastic--a non-invasive low-cost method allowing accurate screening was looked for. Color-Doppler was employed by many authors to evaluate renovascular hypertension, for both the early diagnosis of the condition and the evaluation of treatment results in renal artery stenoses. However, the authors agree that color-Doppler cannot play a major role in the screening of renovascular hypertension due to the various qualitative and quantitative variables not being adequately codified, to the lack of a single color-Doppler method and to the difficult comparison of the results from the different units. Nevertheless, improved results are promised by technological evolution, together with the possibility to codify color-Doppler variables more easily repeatable. B-mode units with 3.5 and 5 MHz probes were employed in the thinnest subjects. In 5-25% of cases accessory renal arteries were observed. After identifying the vessel to be studied with several spatial scans, the smallest possible sample volume (usually 3-5 mm) was positioned. The normal flowmetric range was 0.07-0.1 s: it must not exceed 0.16 s, with persistence of high diastolic flow. Some authors' criteria were followed to define either stenosis or renal artery obstruction; moreover, pulsatile flow index was considered, together with the resistive index, pulsatility index and stenosis index.
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PMID:[Color-Doppler and angioplasty in renovascular hypertension]. 833 15

A 7-year-old child presented with a severe form of Takayasu's arteritis, with two consecutive episodes involving the right testis and then the left kidney 6 months later. The renal artery obstruction was accompanied by severe hypertension. An aortography showed a complete obstruction of the left renal artery and a narrowing of the right subclavian artery. Plasma renin activity was high. Serum immunoglobulins were within the normal range, except for an increase in IgE (880 mu/l). Despite 4 months', treatment with antihypertensive drugs, prednisone, cyclophosphamide, and anticoagulant, the blood pressure never returned to normal and the left renal function remained completely absent. A nephrectomy was performed which immediately normalized plasma renin activity and blood pressure. The child was subsequently treated with alternate-day prednisone for 3 months, alternating with 3 months of cyclophosphamide or, later, azathioprine. Persantine (dipyridamole) and acetylsalicylic acid were administered continuously. The right radial pulse returned to normal within 2 years. An 8-year follow-up failed to detect any new episode of arteritis. The right kidney showed signs of compensatory hypertrophy. Finally, a recent arteriography demonstrated not only a normal right renal artery blood flow but almost total disappearance of the right subclavian artery obstruction. However, the IgE remained abnormally high (2,023 micrograms/l).
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PMID:Long-term immunosuppressive treatment of a child with Takayasu's arteritis and high IgE immunoglobulins. 861 60

1. Low-to-normal renin renovascular hypertension (RVH) and the accuracy of renal vein renin ratios were investigated in 129 consecutive patients referred for suspected RVH. Forty-nine had essential hypertension, 24 unilateral renoparenchymal hypertension and 56 renal artery obstruction. Of the latter, 86% were diagnosed retrospectively as RVH, based on fall in blood pressure with correction of renal ischaemia. We measured baseline, captopril-stimulated and renal vein plasma renin activity (PRA) levels, as well as several other parameters. 2. PRA was low-to-normal in 37% of the RVH patients [low-to-normal renin (LNR-) RVH group] and elevated in the remaining 63% [high-renin (HR-) RVH group]. In the LNR-RVH group, low-to-normal renin levels, by immunoreactive active renin and plasma renin concentration measurements, and a blunted response of PRA to captopril, were seen. As compared with HR-RVH, LNR-RVH patients had a longer duration of hypertension (P < 0.05), higher serum K+ (P = 0.04) and lower diastolic blood pressure (P = 0.02). However, they did not differ for the other variables, including the fall in blood pressure after correction of renal ischaemia. Although the number of bilateral stenoses was similar in the two groups, no patient in the LNR-RVH group had total renal artery occlusion compared with 53% in the HR-RVH group (P = 0.00015). The accuracy of renal vein renin indices were high enough to justify their use only in the patients with total occlusion of a renal artery. 3. Thus LNR-RVH is common in patients with longstanding hypertension without a totally occluded renal artery. Since the sensitivity of renin measurements is low, cure of hypertension would be precluded for more than one third of RVH patients, if these tests were a prerequisite for identifying RVH.
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PMID:Renovascular hypertension with low-to-normal plasma renin: clinical and angiographic features. 948 89

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

This brief review discusses the problem of atherosclerotic renal artery obstruction in the elderly. This disorder is common in the elderly; the overall incidence is estimated to be 10%. The disorder presents with new onset hypertension, a loss of control of BP or a decline in renal function in some patients. In others, the obstruction may be unmasked by the use of angiotensin converting enzyme inhibitors or angiotensin receptor blocker agents. The current approach to the diagnosis of renal artery obstruction is discussed as are the indications for invasive procedures. Careful patient selection for any invasive procedures is particularly important in the elderly since this population has a propensity to higher morbidity.
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PMID:Renal artery disease in the elderly. 1051 51

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 complex disorder, the most common causes of which are fibromuscular dysplasia and atherosclerotic disease. It usually presents in one of three forms: asymptomatic renal artery stenosis, renovascular hypertension, or ischemic nephropathy. This complexity often makes diagnostic and management decisions difficult. This review will be presented in two parts. In Part I, the authors will discuss when to consider and how to go about making the diagnosis. In Part II (in a future issue of The JCH), the authors discuss the management of renovascular disease. The clinical index of suspicion remains paramount in setting the diagnostic strategy. Although it is 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 noninvasive 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. A diagnostic algorithm is proposed at the conclusion of this review.
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PMID:The diagnosis and management of renovascular disease: a primary care perspective. Part I. Making the diagnosis. 1282 84


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