Advances in noninvasive screening for renovascular disease

Nally, Joseph V.; Olin, Jeffrey W.; Lammert, Gary K.

doi:10.3949/ccjm.61.5.328

Cited by 8 publications

(3 citation statements)

References 35 publications

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“…For instance, medical treatment can be used to manage renal artery stenosis, either alone or in combination with revascularization. 43,44 Primary angioplasty can also be used as the primary management modality for cases with renal artery fibromuscular dysplasia. Angioplasty with stent placement can also be offered for patients with atherosclerotic diseases.…”

Section: Treatmentmentioning

confidence: 99%

Hyperaldosteronism: types, clinical characteristics, and treatment

Alsyamy

Kashkari

Alazdi

et al. 2021

Int J Community Med Public Health

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Cases with hyperaldosteronism might be asymptomatic in many events. Therefore, the diagnosis can be missed. However, the usual presentation for many patients has been reported to be a refractory elevation in the blood pressure which might be mild to severe. Based on the type of hyperaldosteronism and the diagnosis, the treatment of these conditions should be established. Therefore, it can be concluded that the treatment is specific to the management of the underlying etiology, and managing the clinical characteristics and associated complications. This present literature review aims to provide evidence regarding the types, clinical characteristics, and treatment of aldosterone based on data from the current investigations in the literature. Different clinical phenotypes have been reported for the condition. Nevertheless, the disease can be broadly classified into primary and secondary hyperaldosteronism based on the pathophysiology and etiology of the condition. Clinical characteristics might not be diagnostic since they are very non-specific, despite being common in these patients, as hypokalemia and hypertension. Therefore, clinicians should be aware of conducting the necessary diagnostic approaches before establishing the diagnosis. Management of these patients requires the integration of different approaches, including surgical and medical treatment. Perioperative care is important because it may lead to unfavorable consequences if neglected.

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Section: Treatmentmentioning

confidence: 99%

Hyperaldosteronism: types, clinical characteristics, and treatment

Alsyamy

Kashkari

Alazdi

et al. 2021

Int J Community Med Public Health

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“…For functional assessment of RVH, captopril loading test (CP-T) [2] and captopril-enhanced 99m Tc-DTPA (diethylenetriamine-pentaacetic acid) renal scintigraphy (CER) [3] were employed. Our methods and interpretation of these examinations were reported elsewhere [4].…”

Section: Methodsmentioning

confidence: 99%

“…Thankfully, much progress has been made on diagnosis and management. We have now simple reliable tests for renovascular hypertension (RVH) [2][3][4] and diagnostic imaging modalities [5,6] that are less invasive than conventional arteriography, all of which could even make the diagnosis possible on an outpatient basis. Ever developing 25 interventional modalities are instrumental in rendering the revascularization procedure less invasive [7,8], while surgical revascularization (SR) has evolved over the years with improved technique [9].…”

Section: Introductionmentioning

confidence: 99%

Surgery for Renovascular Diseases: A Single-Center Experience in Revascularizing Renal Artery Stenosis and Aneurysm

et al. 2002

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Objective: Diagnosis and management of renovascular diseases (RVD) at Hokkaido University Hospital was reviewed with particular emphasis on surgical revascularization (SR). Patients and Methods: We studied a total of 33 patients with RVD [16 patients with renal artery stenosis (RAS): group 1, and 17 patients with renal artery aneurysm (RAA): group 2, 10 males, 23 females, aged 9–69 years (median 46), unilateral 24, bilateral 9]. Functional diagnosis of RVD with regard to renovascular hypertension (RVH) was done with the captopril test (CP-T) and captopril-enhanced ^99mTc-DTPA (diethylenetriamine-pentaacetic acid) renal scintigraphy (CER). All were subjected to SR. Number, length, size and site of RVD with involvement of branch arteries dictated the choice of operative method but basically in situ repair for main trunk disease (11 kidneys) and ex vivo bench repair with autotransplantation for those beyond the first bifurcation intrarenally involving branched arteries (24 kidneys) were employed. The outcome was analyzed as to blood pressure control, split renal function, and branch renal artery patency. Results: (1) Sensitivity of CP-T and CER was 79 and 77% respectively in group 1, while it was 40 and 38% respectively in group 2. (2) Blood pressure was cured in 66.7% (group 1, 68.8% and group 2, 63.6%) and improved in 22.2% (group 1, 18.8% and group 2, 27.3%) with an overall success rate of 88.9%. (3) Renal function was good in 81.3% (group 1, 83.3% and group 2, 78.6%) and fair in 9.4% (group 1, 0% and group 2, 21.4%) with overall success in 90.7%. (4) Patency was preserved in 90.5% of branch anastomoses. Conclusions: Despite challenging complexities, SR of RVD is feasible with a reasonable amount of morbidity and effective in controlling blood pressure and preserving renal function in the majority of cases.

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