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

Renovascular disease represents an important dimension of hypertension. Although estimates vary regarding the exact prevalence of renovascular hypertension, it is being diagnosed with increasing frequency because of refined criteria for the workup and the availability of sensitive diagnostic tests. Two major pathologic entities--atherosclerosis and fibromuscular dysplasia--account for most cases of renovascular hypertension. Once the diagnosis and clinical significance of renal artery stenosis in a hypertensive patient are established, appropriate and specific therapy should be considered. The goal is not only to treat hypertension, but to preserve and restore renal function. Although antihypertensive drug therapy may lower the blood pressure, reperfusion of the kidney (surgical, angioplasty) is a desirable long-term objective in the management of patients with renovascular hypertension. With careful selection of therapeutic choices, we are now able to render optimal care to patients with renovascular hypertension.
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PMID:Current concepts in renovascular hypertension. 164 57

A 64-year-old, hypertensive female suddenly experienced severe headache. On admission, the patient had almost clear consciousness but was slightly restless and complained of severe headache and nausea. Neurological examination revealed only neck stiffness. A computed tomographic scan revealed subarachnoid hemorrhage. Angiographically, bilateral internal carotid and vertebral arteries had the "string of beads sign" at their cervical portion, and the left internal carotid artery also had the same sign at its cavernous portion. The left vertebral artery had low-origin posterior inferior cerebellar artery and a berry-shaped aneurysm at its distal trunk. A diagnosis of cervical and intracranial fibromuscular dysplasia (FMD) with a ruptured berry-shaped aneurysm of the distal vertebral trunk was made. The berry-shaped aneurysm was successfully treated with proximal clipping. Angiographically, right renal and axillary arteries also had the "string of beads sign," and the patient's hypertension seemed to be renovascular in etiology. The co-existence of intracranial FMD and cerebral aneurysm of unusual location suggests a possible relationship between the FMD and the development of cerebral aneurysm.
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PMID:[Fibromuscular dysplasia of the cervical arteries associated with a distal vertebral trunk aneurysm. Case report]. 170 73

A comparative study was made on two groups of children comprising 20 patients with renal hypoplasia/dysplasia in one group and 12 patients with chronic glomerulonephritis (GN) in the other, presenting with chronic renal failure (CRF) in the Department of Paediatrics, Singapore General Hospital and National University Hospital between 1975 and 1989. The age of onset of CRF, the progression of renal failure and the presence of various clinical complications were analysed and compared. The mean age of onset of CRF was earlier in patients with renal hypoplasia/dysplasia (p less than 0.001) but the progression of renal failure in these patients were slower (p less than 0.005). Hypertension occurred more frequently in the chronic GN group (p less than 0.001) while urinary tract infection (UTI) occurred more frequently in the renal hypoplasia/dysplasia group (p less than 0.004). With the early onset of renal failure and slow deterioration of renal function in patients with renal hypoplasia/dysplasia, the provision of good conservative treatment for renal failure is most important in the management of these patients. In the chronic GN patients however, with the rapidity of deterioration of renal function, early preparation for replacement therapy becomes more imminent. However, renal replacement therapy in end-stage renal failure (ESRF) is costly and not readily available, it is more prudent to delay the onset of ESRF by providing effective conservative treatment of renal failure which includes the early recognition and treatment of hypertension in chronic GN and UTI in renal hypoplasia/dysplasia.
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PMID:Comparison of progression of renal failure in children with hypoplastic-dysplastic kidneys and chronic glomerulonephritis. 178 70

Cystic kidney dysplasias (multicystic kidney disease) are differentiated from hyperplastic and ectatic cystic kidney diseases by means of pathogenesis in order to simplify the common classification. Six cases of cystic kidney dysplasia are reported (1 child and 5 adults) and in a review of the literature diagnostic and therapeutic strategies are discussed. A characteristic radiological sign is the clublike++ deformation of the rudimentary ureter. Nephrectomy is indicated in case of symptoms such as pain, hypertension or recurrent urinary tract infections or in case of atypical cysts with a risk of malignancy.
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PMID:[Differential diagnosis of cystic kidney dysplasias]. 182 34

Percutaneous transluminal angioplasty (PTA) was used to treat 66 patients with 85 renal artery stenoses due to fibromuscular dysplasia. The hypertension was refractory to medical management in 46 patients, and the initial success rate was 100%. Clinical follow-up has been obtained in all patients, who were followed for as long as 121 months. The recurrence rates were 8% of lesions and 10% of patients. Cumulative patency rate predicted for 10 years was 87.07%. The mean systolic pressure decreased by 52 mm Hg and the mean diastolic pressure decreased by 35 mm Hg in response to treatment. Twenty-six patients (39%) were cured, 39 (59%) were classified as improved, and one (2%) did not respond to PTA. Fourteen of the patients also had elevated blood urea nitrogen and creatinine levels. Renal function was improved in 86% of the patients and stabilized in 14% of the patients. Analysis of the long-term results suggests that PTA should be the initial treatment for choice of patients with fibromuscular dysplasia in the renal arteries.
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PMID:Results and complications of angioplasty in fibromuscular disease. 182 43

This paper presents the long term results following operative reconstruction for renovascular hypertension in 115 patients operated upon over a period of 20 years. There were 71 (61.7%) males and 44 (38.3%) females with a median age of 46 years (range 16-67). Renal revascularization was unilateral in 96 (83.4%) cases and bilateral in 19 (16.6%). Dacron knitted bypass grafts, were used in 51 and PTFE in 33 instances. Saphenous vein grafts were used in 11 patients. In 15 cases treatment was by local endarterectomy with concomitant angioplasty (12 unilateral and 3 bilateral). Simultaneous aortorenal reconstruction was undertaken in 38 (33%) patients. There were no deaths in the group with isolated renal artery reconstruction. In the group of aortorenal reconstructions, two deaths were encountered (5.7%). Postoperatively, blood pressure was either normal or improved in 83 (72%) patients at a mean follow-up period of 48.3 months (range 1-195 months). The best results were obtained in younger individuals with segmental renal artery lesions. Linear progression analysis, showed age to be a major determinant in the postoperative response to hypertension. There was a greater degree of long term success in patients with fibromuscular dysplasia, as compared to individuals with atherosclerosis. Crude survival probabilities, were 78% and 61% at 5 and 10 years respectively. Late deaths encountered in the present series, were mostly attributable to myocardial infarction (7.8%). In this series, the best results were obtained in individuals younger than 50 years of age, with segmental renal artery lesions.
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PMID:Surgical treatment of renovascular hypertension and respective late results. A twenty years experience. 182 96

Secondary hypertension represents about 5-10% of all forms of hypertension, renal and renovascular being the commonest forms. Renal artery stenosis is the principal cause of renovascular hypertension due to atheromatous disease or fibromuscular dysplasia. Rapid sequence intravenous pyelogram, isotope renogram, captopril test and digital subtraction angiography or conventional arteriography, are the diagnostic procedures in the diagnosis of renal artery atenosis. Hypertension is also very common in parenchymal renal disease, mainly in chronic renal insufficiency. In this condition, the mechanism is more related to volume dependent factors than in renovascular hypertension which is mainly renin dependent. In the treatment of renal or renovascular hypertension the same type of drugs have been generally used as in essential hypertension although with some specific indications like the use of angiotensin-converting enzyme inhibitors in unilateral renal artery stenosis or furosemide in case of renal insufficiency. Revascularization by angioplasty or surgical bypass, may be indicated in renovascular hypertension.
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PMID:[Hypertension from the nephrologist's point of view]. 183 18

A young female patient with renovascular hypertension due to fibromuscular dysplasia of the right renal artery presenting with stroke is described. The patient was treated by renal angioplasty.
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PMID:Renal angioplasty in a case of renovascular hypertension presenting with stroke. 183 6

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

Spontaneous renal artery dissection is an uncommon cause of renovascular hypertension, usually associated with fibromuscular dysplasia. Among reported nonautopsy cases (N = 80), arterial reconstruction has seldom been attempted (N = 21) and the outcome has frequently been poor (48% clinical failure rate). This is attributed in part to the frequent involvement of renal artery branches by the dissection. Furthermore, the report of spontaneous reversion to normotension among patients treated medically has also clouded the role of surgery in this disease. Since progress in the technique of renal artery repair now allows successful treatment of anatomically complex lesions, we reviewed our experience with arterial reconstruction in the management of spontaneous renal artery dissection to determine the frequency of and factors correlating with cure after operative repair. Ten patients (eight men, two women; mean age, 39.3 +/- 5.9 years) were admitted with severe hypertension (10/10), often associated with neurologic symptoms, hematuria, or flank pain (8/10). Serum creatinine was elevated in only two patients. Angiography demonstrated changes consistent with fibromuscular dysplasia in 7 of 10 patients and evidence of dissection in 6 of 10. Bilateral disease was present in three patients. Only five patients had a single renal artery on the involved side. The dissection extended into the primary branches in 8 of 10 patients and involved both renal arteries in four of the five patients with two arteries. Histologic study confirmed fibromuscular dysplasia in six and intramural dissection in all operative specimens. Five patients underwent revascularization (in one case requiring the ex vivo technique), with use of hypogastric artery as a conduit in four of five or resection and primary reanastomosis in one of five. Three patients became normotensive, and two returned to their previous level of blood pressure control. Follow-up averaged 14.5 years. Two patients underwent nephrectomy after exploration demonstrated nonreconstructible vessels, and two underwent nephrectomy when intraoperative assessment of the kidney showed that revascularization had failed to adequately reverse extensive renal ischemia. After a mean follow-up of 14.6 years these patients remain normotensive, although two require antihypertensive medications. One patient was treated medically and is currently hypertensive off all medications. Nine of 10 patients have maintained a normal serum creatinine during follow-up. We conclude that renal revascularization is frequently successful in spontaneous renal artery dissection (five of seven, 71.4%) and results in sustained relief of hypertension with maximal conservation of renal tissue. This is important because of the young age at onset and the not infrequent occurrence of bilateral fibromuscular dysplasia, and even of dissection.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The role of arterial reconstruction in spontaneous renal artery dissection. 192 Jun 44


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