chronic vascular diseases (vasorenal hypertension)
TRANSCRIPT
CHRONIC VASCULAR DISEASES(Vasorenal Hypertension)
BYASOGWA INNOCENT KINGSLEY
ML-508
Anatomy of Kidney
Renal Vasculaturea. Renalis, branches off from abdominal aorta, just
below superior mesenteric artery
Renal Physiology
Etiology Of Vasorenal HypertensionCongenital
Fibromuscular dysplasia( common)AtresiaHypoplasia of renal arteryAngiomaAneurysmArteriovenous fistula
AcquiredAtherosclerosis(common)Nonspecific aortoarteritisNephroptosisThrombosis and EmbolismTraumaTumour
Fibromuscular dysplasia
Congenital diseaseAffects women more frequentlyCommonest cause of
renovascular hypertension among young patients
Degenerative disease affecting Tunica intima and Tunica Media of arteries
Multiple stenosis with intermittened dilatation of the artery
Common cause of aneurysm in smaller branches of renal artery
Atherosclerosis
Pathogenesis Vasorenal Hypertension
Decrease in Renal blood flow stimulates juxtaglomerular apparatus – increase Renin secretion
Increased renin causes conversion of angiotensinogen to angiotensin 1 and then to angiotensin 2
Acting on the vessels causing vasoconstriction and acting on the adrenal cortex, releasing aldosterone
Increased Sodiun and water retension therefroe increasing extracellular fluid causing leg edema and increased blood pressure.
Reduced glomerular filtration, Atrophy of affected kidney, renal failure, Hypertrophy of the contralateral kidney, Development of atherosclerosis of the contralateral renal artery
Clinical SymptomsComplaints of high blood pressure
- headache( particularly at the back of the head and in the morning), dizziness, tinnitus( buzzing or hissing in the ear), vertigo, altered vision or fainting episodes, palpitation, chest pains
Decreased renal functionConcommitent disturbances in other arterial beds
- Pain in lower and upper extremities etc.
DiagnosisAnamnesis
HypertensionPain in loins and lower back
Auscultation-murmur(abdominal bruits) on inferior costal margin of affected side
Doppler ultrasonography Renography (isotope method)Angiography
Doppler US of Renal Artery
http://www.gehealthcare.com/usen/ultrasound/education/products/cme_ren_art.html#6
Angiography
Severe renal artery stenosis, diagnosis confirmed by following angiography
http://www.bmj.com/content/320/7242/1124.full
Differential DiagnosisPheochromocytomaCushing’s DiseaseCon’s SyndromeThyroid Diseases
Conservative TreatmentIndicated for old patients with systemic vascular
pathologyTreatment of hypertension
Enalapril 20mg/day (ACE-inhibitor)Hydrochlorothiazide 12.5 mg/day
Treatment of Acute Thrombosisrt-PA (Alteplas)
Prophylaxis of thrombosisAspirin 75 mg daily (Clopidogrel 75 mg daily combined with Aspirin)Simvastatin 20mg/day (esp. Indicated for obese ptnt.)
Surgical TreatmentThrombendarterectomy with patch graftRenal artery bypass surgeryNephrectomy
Thrombendarterectomy with Patch graft
Renal artery bypass surgery
Endovascular TreatmentPercutaneous transluminal angioplasty (Balloon
angioplasty)
Placement of Stent
ComplicationsHemorrhageInfectionEarly and Late Thrombosis of StentOcclusion, dissection and perforation of renal
arteryContrast nephrotoxicity
PrognosisUntreated:
Severe hypertension with damage to cardiovascular systemBilateral renal failure Intoxication, Encephalopathy, Coma, Death
Treated (Depends on the duration of pathology and level of organ damage)Focal disease i.e. Atherosclerotic disease limited to one renal
artery; good prognosis with lowered arterial blood pressure and decreased antihypertensive medication.
Diffuse generalised atherosclerosis with secondary damages to kidney and other organs; poor prognosis with risk of developing firther organ damage.