Renal Arterial Disease and Hypertension

Textor, Stephen C.

doi:10.1016/j.mcna.2016.08.010

Cited by 54 publications

(46 citation statements)

References 46 publications

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“…Atherosclerotic disease commonly involves the ostium and the proximal third of the main renal artery. Atherosclerosis accounts for more than 90% of RAS lesions [1][2]. Atherosclerotic renovascular lesions are common in the elderly, diabetics, patients with aortoiliac disease, hypertension, coronary artery disease, and peripheral artery disease.…”

Section: Reviewmentioning

confidence: 99%

“…Fibromuscular dysplasia typically presents in younger females with hypertension. Fibromuscular dysplasia commonly involves the distal two-thirds of the main renal artery and its branches [1][2][3]. Angiography commonly demonstrates the classic 'string of beads' appearance and the location within the renal artery in fibromuscular dysplasia, which helps differentiate it from atherosclerotic renovascular lesions.…”

Section: Reviewmentioning

confidence: 99%

“…A majority of renovascular lesions are attributed to atherosclerosis. Renovascular hypertension secondary to renal artery stenosis is a frequent curable etiology of secondary hypertension [1][2]. Renal hypoperfusion from RAS activates the renin-angiotensin system, which in turn causes volume expansion and elevation of systemic blood pressure due to the vasoactive effects of aldosterone and angiotensin II.…”

Section: Introductionmentioning

confidence: 99%

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Renal Artery Stenosis As Etiology of Recurrent Flash Pulmonary Edema and Role of Imaging in Timely Diagnosis and Management

Bhattad¹,

Jain²

2020

Cureus

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Renal hypoperfusion from renal artery stenosis (RAS) activates the renin-angiotensin system, which in turn causes volume overload and hypertension. Atherosclerosis and fibromuscular dysplasia are the most common causes of renal artery stenosis. Recurrent flash pulmonary edema, also known as Pickering syndrome, is commonly associated with bilateral renal artery stenosis. There should be a high index of clinical suspicion for renal artery stenosis in the setting of recurrent flash pulmonary edema and severe hypertension in patients with atherosclerotic disease. Duplex ultrasonography is commonly recommended as the best initial test for the detection of renal artery stenosis. Computed tomography (CT) angiography (CTA) or magnetic resonance (MR) angiography (MRA) are useful diagnostic imaging studies for the detection of renal artery stenosis in patients where duplex ultrasonography is difficult. If duplex ultrasound, CTA, and MRA are indeterminate or pose a risk of significant renal impairment, renal angiography is useful for a definitive diagnosis of RAS. The focus of medical management for RAS relies on controlling renovascular hypertension and aggressive lifestyle modification with control of atherosclerotic disease risk factors. The restoration of renal artery patency by revascularization in the setting of RAS due to atherosclerosis may help in the management of hypertension and minimize renal dysfunction.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Renal Artery Stenosis As Etiology of Recurrent Flash Pulmonary Edema and Role of Imaging in Timely Diagnosis and Management

Bhattad¹,

Jain²

2020

Cureus

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“…Renovascular disease is characterized by unilateral or bilateral renal artery stenosis (RAS). In Western populations 90% of RAS is caused by atherosclerotic renal artery stenosis (ARAS), and 10% by fibromuscular dysplasia (FMD) ( Textor, 2017 ). ARAS affects 7% of North Americans aged over 65 years ( Hansen et al, 2002 ), and the incidence is rising due to aging, obesity, diabetes, and hypertension ( Kalra et al, 2005 ).…”

Section: Introductionmentioning

confidence: 99%

“…FMD affects 0.4% of the population and is seen in younger patients ( Slovut and Olin, 2004 ). Reduced renal perfusion causes progressive chronic kidney disease (CKD) and drives neurohormonal activation with subsequent resistant hypertension, end-stage kidney disease, and death ( Textor, 2017 ). Major trials testing efficacy of reperfusion by angioplasty and stenting demonstrated no benefit beyond drug therapy (antihypertensives and statins) ( Wheatley et al, 2009 ; Riaz et al, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

Non-invasive Stenotic Renal Artery Haemodynamics by in silico Medicine

et al. 2018

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Background: Measuring the extent to which renal artery stenosis (RAS) alters renal haemodynamics may permit precision medicine by physiologically guided revascularization. This currently requires invasive intra-arterial pressure measurement with associated risks and is rarely performed. The present proof-of-concept study investigates an in silico approach that uses computational fluid dynamic (CFD) modeling to non-invasively estimate renal artery haemodynamics from routine anatomical computed tomography (CT) imaging of RAS.Methods: We evaluated 10 patients with RAS by CT angiography. Intra-arterial renal haemodynamics were invasively measured by a transducing catheter under resting and hyperaemic conditions, calculating the translesional ratio of distal to proximal pressure (Pd/Pa). The diagnostic and quantitative accuracy of the CFD-derived virtual Pd/Pa ratio (vPd/Pa) was evaluated against the invasively measured Pd/Pa ratio (mPd/Pa).Results: Hyperaemic haemodynamics was infeasible and CT angiography in 4 patients had insufficient image resolution. Resting flow data is thus reported for 7 stenosed arteries from 6 patients (one patient had bilateral RAS). The comparison showed a mean difference of 0.015 (95% confidence intervals of ± 0.08), mean absolute error of 0.064, and a Pearson correlation coefficient of 0.6, with diagnostic accuracy for a physiologically significant Pd/Pa of ≤ 0.9 at 86%.Conclusion: We describe the first in silico estimation of renal artery haemodynamics from CT angiography in patients with RAS, showing it is feasible and diagnostically accurate. This provides a methodological framework for larger prospective studies to ultimately develop non-invasive precision medicine approaches for studies and interventions of RAS and resistant hypertension.

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Free‐breathing three‐dimensional isotropic‐resolution MR sequence for simultaneous vessel wall imaging of bilateral renal arteries and abdominal aorta: Feasibility and reproducibility

et al. 2022

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Purpose: Many diseases can simultaneously involve renal arteries and the adjacent abdominal aorta. This study proposed a free-breathing threedimensional (3D) isotropic-resolution magnetic resonance sequence for simultaneous vessel wall imaging (VWI) of bilateral renal arteries and adjacent abdominal aorta. Methods: A respiratory-triggered isotropic-resolution sequence that combined the improved motion-sensitized driven-equilibrium (iMSDE) preparation with the spoiled gradient recalled (SPGR) readout (iMSDE-SPGR) was proposed for simultaneous VWI of renal arteries and abdominal aorta. The proposed iMSDE-SPGR sequence was optimized by positioning spatial saturation pulses (i.e., REST slabs) elaborately to further alleviate respiratory and gastrointestinal motion artifacts and selecting appropriate first-order gradient moment (m 1 ) of the iMSDE preparation. Thirteen healthy subjects and 13 patients with renal artery stenosis underwent simultaneous VWI with the optimized iMSDE-SPGR sequence at 3.0 T. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and morphology of renal arterial wall and aortic wall were measured. Reproducibility of intra-observer, inter-observer, and scan-rescan (n = 13 healthy subjects) in measuring SNR, CNR, and morphology was evaluated. For the reproducibility test, the agreement was determined using intraclass correlation coefficients (ICC), and the differences were compared using paired t-test or nonparametric Wilcoxon test when appropriate. Bland-Altman plots were used to calculate the bias between observers and between scans. Results:The proposed iMSDE-SPGR sequence was feasible for simultaneous VWI both in the healthy subjects and the patients. The sequence showed good to excellent inter-observer (ICC: 0.615-0.999), excellent intra-observer (ICC: 0.801-0.998), and scan-rescan (ICC: 0.768-0.998) reproducibility in measuring morphology, SNR, and CNR. There were no significant differences in SNR, CNR, and morphology measurements between observers and between scans (all p > 0.05). Bland-Altman plots showed small bias in assessing SNR, CNR, and morphology. Data conclusion: The proposed free-breathing 3D isotropic-resolution iMSDE-SPGR technique is feasible and reproducible for simultaneous VWI of bilateral renal arteries and adjacent abdominal aorta.

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Renal Arterial Disease and Hypertension

Cited by 54 publications

References 46 publications

Renal Artery Stenosis As Etiology of Recurrent Flash Pulmonary Edema and Role of Imaging in Timely Diagnosis and Management

Renal Artery Stenosis As Etiology of Recurrent Flash Pulmonary Edema and Role of Imaging in Timely Diagnosis and Management

Non-invasive Stenotic Renal Artery Haemodynamics by in silico Medicine

Free‐breathing three‐dimensional isotropic‐resolution MR sequence for simultaneous vessel wall imaging of bilateral renal arteries and abdominal aorta: Feasibility and reproducibility

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