Renovascular hypertension: A report of 21 cases

Abstract

Renovascular hypertension (RVH) is among the most common forms of secondary hypertension. We studied 21 patients (eight male and 13 female) with RVH who were encountered during a period of 16 years. The average age of the patients was 34.75 years. Trans-renal Doppler ultrasound confirmed the diagnosis of renovascular stenosis (RAS) as the cause of RVH in 95% of the patients. Computed tomography angiography was performed in ten cases, which confirmed the diagnosis in all these cases. Magnetic resonance angiography was performed in only three patients. Renal scintigraphy was performed in 11 patients, with DTPA in nine patients and with MAG3 in two cases. Arteriography was performed in 15 cases for therapeutic end points. In two patients, we treated the arteries of both kidneys and in 19 cases we treated only one kidney artery. Percutaneous transluminal angioplasty was performed in ten cases. Renal arterial stent placement was performed in three cases in which RAS was from an atherosclerosis etiology. Surgical revascularization was performed in four cases. Nephrectomy was necessary in four cases. After interventional treatment, medical treatment using antihypertensive drugs was necessary in 17 of the patients. After treatment, three patients returned to normal kidney function, while worsening of glomerular filtration rate was noted in four patients. Some complications such as a kidney infarct after treatment, a nephrectomy, artery thrombosis, an ischemic stroke and recurrent RAS were also noted.

Denervação De Artéria Renal Em Paciente Com Hipertensão Arterial Refratária

“…Consequentemente à esta hipoperfusão,ocorrem ativação de vias inflamatórias nos rins, levando a estresse oxidativo e disfunção endotelial que podem culminar em nefropatia isquêmica e fibrose intersticial do parênquima renal. 4,5 São causas conhecidas de HSEC renovascular: aterosclerose de artéria renal, displasia fibromuscular, arterite de takayasu. Estas seriam as causas mais descritas, sendo o diagnóstico de aterosclerose percentualmente mais diagnosticado.…”

Hipertensi Renovaskular

“…Hipertensi renovaskular adalah peningkatan tekanan darah sistolik dan atau diastolik yang umumnya mendadak dan resisten akibat hipoperfusi ginjal yang biasanya disebabkan stenosis arteri renalis dan aktivasi sistem renin-angiotensin. 1 Hipertensi renovakular dapat terjadi karena gangguan pada vaskular, berkaitan dengan penyakit parenkim ginjal atau dapat juga merupakan kombinasi dari keduanya. Hipertensi renovaskular merupakan 1-4 % dari seluruh penderita hipertensi.…”

Bone marrow-derived mesenchymal stem cells transplantation ameliorates renal injury through anti-fibrotic and anti-inflammatory effects in chronic experimental renovascular disease

“…In 2K1C model, partial occlusion of the renal artery (stenosis) leads to reduced blood flow and perfusion pressure, causing renovascular hypertension (RVH), a disease regarded as a secondary hypertension form in humans [ 14 ]. Renal artery stenosis activates the renin–angiotensin–aldosterone system (RAAS), promoting oxidative stress, inflammation, microvascular loss, severe interstitial fibrosis and tubular atrophy, resulting in functional kidney deterioration [ 12 , 13 ] and further progress to CKD and renal failure [ 15 ]. We have recently shown that MSC renal subcapsular administration led to a significant reduction in blood pressure arguing a strong effect on renin release by actions on juxtaglomerular apparatus.…”