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

A study of 44 hypertensive patients with unilateral renovascular or renal parenchymal disease is presented. All patients underwent corrective surgery. Out of the 44 operated patients, five did not participate in the follow-up examination. The remaining 39 patients constitute the study population. The effects of surgery on the hypertensive state could be evaluated in 35 patients, whereas four died less than two months after the operation. Follow-up studies were carried out at 8-60 months after the operation. The average period of observation was 32 months; 24 patients were observed for more than two years. As a group, the patients had severe hypertension with extensive target organ damage and widespread atherosclerosis. A fairly rigorous selection process was applied, and an unsatisfactory response to medical management was considered a point of major importance. In the majority of cases, renovascular lesions were atherosclerotic, with only two cases of fibromuscular dysplasia. Unilateral nephrectomy was performed in 32 patients, whereas seven underwent reconstructive vascular surgery. Out of 35 patients, 22 (63%) were cured, 8 (23%) improved and 5 (14%) unaltered. A gratifying regression of hypertensive lesions in target organs was observed in patients who were cured or improved by surgery. The frequency and severity of postoperative complications were related to the presence of extrarenal vascular disease.
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PMID:A follow-up study of hypertensive patients after operative treatment of unilateral renovascular or renal disease. 47 83

147 operations for renovascular hypertension were performed in 125 patients. 136 of the operations were vascular reconstructions. Aortorenal by-pass, using saphenous vein as a graft, was found to be a satisfactory technique. An aneurysmatic dilatation developed twice, which on both occasions was attributed to a stenosis proximal to the graft. Two failures also occurred among the 12 patients undergoing renal autotransplantation, both due to an illiac vein thrombosis, obstructing the renal vein. The majority of the six deaths were due to myocardial infarctions or uremia. They all occurred in the eldest patients (older than 59 years) and in patients suffering from complicating cardiac or renal disease. The results with regard to blood pressure were very good in fibrous dysplasia and in atherosclerosis affecting only one side. Operative treatment can therefore be recommended to these groups of patients even in relatively mild hypertension. The indication to operate should be restricted in elderly patients suffering from cardiac and renal complicating diseases, and in patients with bilateral atherosclerotic stenosis.
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PMID:Technique and complications in the surgical treatment of renovascular hypertension. 49 59

Severe segmental renal atrophy with loss of parenchymal elements in small kidneys is commonly known as segmental hypoplasia. The scars are seen as cortical depressions overlying shrunken medullary pyramids and their dilated calyces, and are characterized histologically by colloid-filled tubular microcysts and a paucity or absence of glomeruli. This lesion has been identified in 17 patients, 11 female and 6 male, between 6 and 23 years of age. Eleven patients had hypertension, which developed in six while they were under observation. Thirteen had histories of urinary tract infection, and 16 had evidence of vesicoureteric reflux. Seven patients had impaired renal function (GFR less than 40 ml/minute/1.73 m2). Abnormal metanephric differentiation (dysplasia) in two specimens, one in association with posterior urethral valves, suggested an occasional intrauterine origin of the abnormality. Twelve patients had radiographic evidence of decreasing renal size over two to five years of observation, even after surgical correction of reflux, in four of them unaccompanied by infection. We conclude that segmental "hypoplasia" is an acquired lesion, although it sometimes has intrauterine origins, and that it is commonly associated with vesicoureteric reflux, even in the absence of demonstrable infection.
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PMID:Segmental "hypoplasia" of the kidney (Ask-Upmark). 50 98

The writers record a severe case of renovascular hypertension resulting from fibromuscular dysplasia which appeared in the only main left renal artery. The first clinical symptoms were noticed at five months. The failure of medical treatment led to exploratory surgery at seven months with renal revascularisation by an aortorenal by-pass using a hypogastric arterial autograft. The writers stress the scarcity of hypertension symptoms among infants of less than one year and conclude the impossibility of prognosis in spite of an apparent cure after six months.
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PMID:[Renovascular hypertension in infancy treated by aortorenal by-pass (author's transl)]. 54 84

A patient with a single functioning kidney presented with the nephrotic syndrome. On the basis of highly selective proteinuria, a diagnosis was made of lipoid nephrosis. Steroid therapy over a 2-year period did not control the disease. The patient eventually developed end-stage renal failure and malignant hypertension. Nephrectomy was performed to control the hypertension. Histological examination showed congenital dysplasia in one kidney and sclerosing glomerulonephritis, malignant nephrosclerosis, as well as dysplastic changes in the other.
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PMID:Sclerosing glomerulonephritis and malignant hypertension in a patient with congenital renal dysplasia: A case report. 55 Apr 41

The morphological picture of bioptic renal tissue was studied in 23 patients with different forms of vasorenal hypertension, among whom 12 had fibromuscular dysplasia of the renal arteries, 8 had atherosclerotic stenosis, and 3 had panarteritis of the aorta and its branches with involvement of the renal arteries. The syndrome of malignant hypertension was encountered in 13 patients and stable arterial hypertension with high blood pressure levels in 10 patients. Analysis of the bioptic material allowed it to be divided into two groups: the 1st was marked by a picture of "Selye's kidney" and the 2nd by a combination of stenosis of the renal arteries and parenchymatous diseases of the kidneys. The significance of examining the morphological picture of renal bioptates, both with regard to the study of the pathogenesis of vasorenal hypertension and the diagnosis of concomitant parenchymatous process is shown.
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PMID:[Value of puncture biopsy of the kidneys on the side of the stenosis in renovascular hypertension. I]. 59 97

A 24 year old female with severe renovascular hypertension resulting from bilateral fibromuscular dysplasia was successfully treated surgically. The internal iliac artery was used for a left aortorenal grafts. The right renal artery was dilated through the amputated left renal stump. Although saphenous vein graft is most commonly used, the autogenous internal iliac artery is considered a satisfactory graft in aortorenal reconstruction, especially for a young patient.
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PMID:Autogenous internal iliac artery bypass in the surgical treatment of renovascular hypertension: a case report. 65 Oct 24

We have found 3 reports of fibromuscular hyperplasia (FMH) of the renal arteries with hypertension occurring in 2 siblings as well as a few instances of renal agenesis and unilateral renal aplasia occurring in the same family. In this paper we report on FMH of the renal arteries in 2 women, one giving birth to a child with renal agenesis, the other to a child with a focally dysplastic hypoplasia of the kidneys. A third family is reported, heavily loaded with hypertension and otosclerosis, in which 2 siblings with FMH and otosclerosis were found. Another 4 patients without known heredity for hypertension, but with FMH combined with renal or urinary tract anomalies, are also reported. The findings are discussed, particularly in relation to the findings in a large material of chronic non-obstructive pyelonephritis, where in those with well maintained renal function, hypertension below the age of 40 was found predominantly in females with a positive family history of hypertension and signs highly suggestive of infected hypoplasia or dysplasia of the kidney.
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PMID:Combination of fibromuscular hyperplasia, renal aplasia, hypoplasia or dysplasia and otosclerosis occurring in the same individual or the same family. 66

Fifty-seven cases admitted to the Karolinska Hospital 1973-1976 with the diagnosis transient cerebral ischemia were reviewed. Seventeen cases were excluded as not fulfilling the strict TIA definition. An analysis of the records and the supplementary questionnaire of the remaining cases showed considerable sex differences in the stroke-prone profile. In the male group arteriosclerosis in the extracranial cerebral arteries was demonstrated in 90% of these examined by angiography. In the female group factors recognized as interfering with the coagulation system were obvious in more than 70% and two women had fibromuscular dysplasia. These differences may have therapeutic and prognostic implications. In the total material only 35% had hypertension. Diabetes was not present in any of the patients. Of the men 46.6% had abnormal blood lipids against 15.4% of the women. Seventy-five percent of the patients with verified arteriosclerosis were regular smokers. At a mean follow-up time of 18.7 months only one patient, in the untreated group, developed completed stroke.
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PMID:Pathogenetic profile of TIA before 55. A three-year investigation. 68 66

Renovascular disease often leads to hypertension in children. The most frequent cause is fibromuscular dysplasia of focal type affecting main and peripheral arteries. Diastolic readings in excess of 110 mm Hg with normal serum creatinine and urinalysis are suggestive of renovascular disease. Excretory urography was positive in 65% of patients with unilateral disease. Radionuclide scans complement a positive excretory urogram but may be positive when the urogram is negative. Plasma renin activity was raised in the majority of patients; if the patient does not have peripheral branch stenosis, the renal vein renin ratio will lateralize in unilateral renal disease. The overall results of surgery are encouraging: 86% of surgical procedures alleviated hypertension in unilateral disease.
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PMID:Renovascular hypertension in children and adolescents. 69 62


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