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

Renal artery dissection is a rare complication of catheter arteriography. Predisposing factors include atherosclerosis and fibromuscular dysplasia. Optimum management requires aortographic documentation of the extent of vascular obstruction. Dissections causing incomplete obstruction of blood flow can be treated with systemic anticoagulation to prevent downstream thrombosis and should be followed with serial isotope blood flow studies and LDH measurements. Dissection causing complete vascular obstruction usually requires immediate surgery, although spontaneous reestablishment of flow may occur. The 3 patients discussed illustrate a spectrum of findings, including the acute development of renovascular hypertension.
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PMID:Renal artery dissection: a complication of catheter arteriography. 117 54

In fourteen children with renovascular hypertension the most prevalent lesion was fibromuscular dysplasia (nine patients). Nephrectomy was performed in four patients prior to the adoption of reconstructive vascular techniques. Revascularization of a variety of lesions was employed with autogenous arterial grafts, which gave excellent results over a long follow-up period in ten patients. Ex vivo microvascular repair was used in one patient rather than nephrectomy for management of branch artery lesions. These results indicate that careful and precise arterial repairs will yield a high cure rate in children with renovascular hypertension without the sacrifice of renal parenchyma.
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PMID:Surgical treatment of renovascular hypertension in children. 118 52

Forty-nine iliac artery autografts were used in the treatment of renovascular hypertension in 45 patients, including six children. The pathological process was fibromuscular dysplasia in 42, atherosclerosis in two, and Takayasu arteritis in one. The internal iliac artery was used as a graft in 39 patients. The common iliac bifurcation was used in two patients, and the external iliac artery in four patients. Common and external iliac artery continuity was restored with Dacron prostheses. Forty-three patients with 47 autografts have been followed up from one to ten years (average three years). Hypertension was cured or improved in 96% of the patients. Serial follow-up arteriograms as late as ten years after surgery have been obtained in 50% of the patients. No late occlusions occurred. Slight autograft dilation occurred seven years postoperatively in one child. Normal growth of the autograft was exhibited in the remaining five children. No evidence of dilation, aneurysm formation, or stenosis appeared in any other grafts, although one patient developed a new lesion distal to her graft.
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PMID:Aortorenal arterial autografts. 119 Oct 25

We report our experience in the treatment of 47 cases of renal hypertension patients with renovascular hypertension or hypertensive reno-parenchymal disease surgical therapy is essential and non-surgical therapy has its limitations. The necessity for an operation can be based on the determination of bilateral renal vein plasma renin values. Blood should be drawn from both renal veins in patients in an upright position. Surgical treatment usually produces excellent results in patients in whom renin activity on the side of the lesion is more than normal and more than 2 times that on the uninvolved side. It is advisable to perform an operation within 4 years of the onset of renal hypertension. Complete surgical cure of renal hypertension is accomplished more frequently in patients with fibromuscular dysplasia than in those atherosclerosis. The therapeutic effect of an operation in correcting hypertension is virtually the same, regardless of whether the arterial stenotic lesions are in the main renal artery or in the intrarenal arterial branches. We have found nephrectomy or dacron bypass graft to be the surgical procedure of choice in renovascular hypertension cases.
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PMID:Therapeutic experience in renal hypertension: response treatment in 47 cases. 123 71

In a review of 156 total or partial nephrectomy specimens from patients over the age of 12 years, renal dysplasia was found 14 times. The cases were divided initially into five groups on the basis of the predominant pathological changes, namely (1) dysplasia (14 cases), (2) chronic pyelonephritis (31 cases), (3) calculous inflammation (58 cases), (4) hydronephrosis (35 cases), and (5) miscellaneous (18 cases). The diagnosis of dysplasia was made on gross and microscopic criteria and included 12 of segmental dysplasia, one of total dysplasia, and one multicystic dysplastic kidney. The principal differential diagnosis is from the irregularly scarred chronic pyelonephritic kidney. The criteria for the separation of the two are emphasized and, in particular, the distinction from those pyelonephritic kidneys with aglomerular scars. A high incidence of anomalies of drainage was found in association with dysplasia, but such were not always present. It was not thought that intrarenal reflux in infancy was an aetiological factor. Six of the cases presented with urinary infection, but only two had hypertension. It was thought that acquired glomerular damage was more important in the aetiology of hypertension than segmental glomerular agenesis.
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PMID:Renal dysplasia in nephrectomy specimens from adolescents and adults. 123 28

Renal venography was performed in a patient suffereing from hypertension due to fibromuscular dysplasia of the renal artery. The venogram revealed morphological changes in the renal veins similar to those seen in fibromuscular dysplasia of the arteries. Histological examination of the veins showed fibrosis of the medial wall layer.
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PMID:Angiographic appearance of the renal vein in a case of fibromuscular dysplasia of the artery. 125 Oct 5

The work deals with the management of vasorenal hypertension in children and adolescents. The Bakulev Institute of Cardiovascular Surgery had 185 children with arterial hypertension from 1965 to 1990. Their ages ranged from 12 months to 17 years. The vasorenal genesis of hypertension was caused by fibromuscular dysplasia (FMD) of the renal arteries in 61 patients, unspecific aortoarteritis (UAA) in 39, hypoplasia of the abdominal aorta, kidneys, and renal arteries in 22 patients, supernumerary renal arteries were found in 7 patients. A total of 119 operations were carried out on 106 patients. Operations and one-stage revascularization of the kidneys and alimentary organs were performed on 22 patients, isolated reconstruction of the renal arteries on 51 patients. Among 99 patients with stenoses and aneurysms of the renal arteries 13 were treated by nephrectomy (11.3%). The postoperative mortality was 0.9%. A hypotensive effect was not produced in the immediate postoperative period in 5 patients with UAA (4.6%) and in one patient with, FMD (0.9%). Six operations were performed in late-term periods after the first operative interventions: 2 for aneurysm of autovenous grafts, 2 for restenosis of the renal arteries, and 2 for stenosis of the aorta distal to the primary site of reconstruction in UAA. Three patients died in the late-term periods. The stability of good operative results was highest in congenital hypoplasia of the aorta--100%. A favorable effect of the operation persists in 89.6% of patients with FMD of the renal arteries. The stability of the effect is lowest (75%) in UAA.
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PMID:[Methods of plastic surgery of the renal arteries in children with vasorenal hypertension]. 128 68

Because the cause of hypertension is reversible in only 5 percent of patients, extensive initial work-up should only be considered in selected cases. Secondary causes should be suspected in patients whose hypertension begins before age 30 or after age 50 and in patients whose hypertension suddenly worsens after a long period of good control, becomes severe or malignant, or remains refractory to maximal medical therapy. A sudden reduction in renal function in a hypertensive patient and the discovery of a unilateral small kidney may also raise suspicion of a secondary cause. Renovascular disease, one of the most common secondary causes of hypertension, is usually the result of atherosclerosis in older patients and the result of fibromuscular dysplasia in younger patients. Physical examination seldom contributes to the diagnosis. The classic upper abdominal or flank bruit occurs in only 30 to 50 percent of patients with renovascular disease, and is not uncommon in patients with essential hypertension. The gold standard for diagnosis of renovascular disease remains the arteriogram. Transluminal renal angioplasty may be performed during arteriography if a high-grade stenosis is identified. Other management options include medical therapy and surgical revascularization with grafts.
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PMID:Percutaneous angioplasty for renovascular hypertension due to fibromuscular dysplasia. 132 61

Over a 16-year period, 205 patients with hypertension were shown to have a renovascular aetiology. Of these, 125 (61 per cent) had Takayasu's arteritis, 58 (28.3 per cent) had fibromuscular dysplasia, 16 (7.8 per cent) had atherosclerosis, five (2.4 per cent) had polyarteritis nodosa and one (0.5 per cent) had renal artery aneurysm. Among patients with Takayasu's arteritis, males were affected as commonly as females. The mean age of these patients at the time of detection was 26.8 +/- 8.6 years (range 5-52 years). Type I arteritis was seen in nine (7.2 per cent), Type II in 40 (32 per cent) and Type III in 76 (60.8 per cent) patients. The abdominal aorta was involved in 117 (93.3 per cent) patients. Takayasu's arteritis was associated with ulcerative colitis in two patients and with renal amyloidosis and focal segmental glomerulosclerosis with a nephrotic syndrome in one patient each. Surgical intervention consisting of bypass procedures, autotransplantation or nephrectomy was performed in 17 (13.6 per cent) and angioplasty in nine (7.2 per cent) patients. Cure and improvement in blood pressure was observed in 82.4 per cent and 77.8 per cent respectively. Adequate control of blood pressure was achieved with drugs only in 22 (22.2 per cent) patients. A definite cause and effect relationship could not be established between any infective or immunological disorder and Takayasu's arteritis. Takayasu's arteritis is a far more common cause of renovascular hypertension in Indian population than fibromuscular dysplasia or atherosclerosis, which are more common in the western population.
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PMID:Renovascular hypertension due to Takayasu's arteritis among Indian patients. 136 62

Over a 16-year period (1973-1989), 63 renal autotransplants were performed in 59 patients for fibro-muscular dysplasia (FMD) with renal artery stenoses (42 kidneys) or aneurysms (21 kidneys). About two-thirds of the autotransplants were performed before percutaneous transluminal angioplasty (PTA) was established for clinical use. However, vascular disease at a site or type not suitable for PTA was present in 57 (90%) of the kidneys. Hypertension was the leading symptom in 56 patients, including four in whom renal autotransplantation was performed as an emergency for acute renal artery occlusion or malignant hypertension. Blood pressure returned to normal or improved in 51 (91%) and remained unchanged in five patients (9%) following autotransplantation. Three patients with renal artery aneurysm in whom haematuria and loin pain were the indications for treatment, became asymptomatic following surgical intervention. Bilateral renal autotransplantation was performed synchronously in one and sequentially in three patients. There were no operative deaths, but two kidneys were lost postoperatively in two 2-year-old children owing to renal vascular thrombosis. In the follow-up period (mean 4.3 years), one additional kidney was lost at 3 months owing to progressive FMD. Blood pressure and renal function remained stable in all other patients. Based on the excellent results achieved in this series, it is concluded that extracorporeal vascular repair and renal autotransplantation is a safe procedure for the patient as well as the kidney affected by FMD. The procedure is advocated as an alternative to in situ reconstruction in patients with renal artery disease not accessible to PTA, such as aneurysms and complex branch renal artery stenoses.
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PMID:Fibro-muscular renal artery disease treated by extracorporeal vascular reconstruction and renal autotransplantation: short- and long-term results. 139 39


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