RENOVASCULAR RENOVASCULAR HYPERTENSION HYPERTENSION 42 cases analysis 42 cases analysis Mihai Dan Datcu, Georgeta Datcu, Viviana Aursulesei, Helen Rothinberg I st Medical Cardiology Clinic “C.I.Negoiţă” I st Medical Cardiology Clinic “C.I.Negoiţă” “ “ St Spiridon” University Emergency Hospital St Spiridon” University Emergency Hospital University of Medicine and Pharmacy “Gr.T.Popa” University of Medicine and Pharmacy “Gr.T.Popa” Iaşi Iaşi
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RENOVASCULARRENOVASCULAR HYPERTENSIONHYPERTENSION
42 cases analysis42 cases analysis
Mihai Dan Datcu, Georgeta Datcu, Viviana Aursulesei, Helen Rothinberg
I st Medical Cardiology Clinic “C.I.Negoiţă”I st Medical Cardiology Clinic “C.I.Negoiţă”
““St Spiridon” University Emergency HospitalSt Spiridon” University Emergency Hospital
University of Medicine and Pharmacy “Gr.T.Popa”University of Medicine and Pharmacy “Gr.T.Popa”
IaşiIaşi
1. 1. Renal artery stenosis is recognised as a cause of Renal artery stenosis is recognised as a cause of hypertension and renal dysfunction;hypertension and renal dysfunction;
2. 2. No single test is appropiate for all patients;No single test is appropiate for all patients;
3. 3. Diagnostic modalities require an assesment of the Diagnostic modalities require an assesment of the physiologic effects of renal artery stenosis, and the physiologic effects of renal artery stenosis, and the direct imaging of renal artery;direct imaging of renal artery;
4. 4. We believe that direct or conventional contrastWe believe that direct or conventional contrast angiography answer in the same time both requiresangiography answer in the same time both requires..
Key points and purposeKey points and purpose
Female Female 32 patients 32 patientsMaleMale 10 patients 10 patientsMinim age Minim age 14 year14 year Maxim ageMaxim age 78 year78 year
Clinical index of suspicion of renovascular Clinical index of suspicion of renovascular hypertensionhypertension
High Moderate Low
Severe hypertensionSevere hypertension-SH- with progresive unexplained renal -SH- with progresive unexplained renal insufficiencyinsufficiency
SHSH with refractoriness to agressive treatment with refractoriness to agressive treatment
Accelerated or Accelerated or malignant Hmalignant H – gr III or IV retinopathy – gr III or IV retinopathy
Moderate to Moderate to SHSH with elevation serum creatinine reversibly with elevation serum creatinine reversibly induced by an ACE inhibitor or angiotensin II antagonistinduced by an ACE inhibitor or angiotensin II antagonist
Moderate to Moderate to SHSH with asym with asymmmetretryy of renal size of renal size
Batzenschlager criteriaBatzenschlager criteria
A.Zancheti A.Zancheti 20012001
Zanchetti A et al, 2001Zanchetti A et al, 2001
Search for etiologySearch for etiology
Age of onset under 20 yAge of onset under 20 yeaearsrs 15 c15 cAge of onset over 50 yAge of onset over 50 yeaearsrs 27 c27 cAbdominal bruit – 41 –57 % (H.Abdominal bruit – 41 –57 % (H. Dustan)Dustan) 16 c16 cEleveted serum creatinineEleveted serum creatinine 14 c14 cHypokaliemiaHypokaliemia 4 c4 cHigh renin profileHigh renin profile 18 c18 cNon invasive testsNon invasive tests 42 c42 c
Infrarenal thrombosis of the abdominal aortaInfrarenal thrombosis of the abdominal aorta
Abdominal coarctation of the aortaAbdominal coarctation of the aorta
Risk of angiography (1 – 3%)Risk of angiography (1 – 3%)
Complications of arterial punctureComplications of arterial puncture 0,5%0,5%Contrast – induced nephropathy Contrast – induced nephropathy 2%2%Cholesterol embolisationCholesterol embolisation 1%1%
presence of presence of - - atherosclerosisatherosclerosis - - hypertensionhypertension - - renal insufficiencyrenal insufficiency - - diabetic patientsdiabetic patients
risk increaserisk increase::
Treatment modalitiesTreatment modalities
Medical treatmentMedical treatment 13 13 Surgical proceduresSurgical procedures
nephrectomie nephrectomie 3 3 conservative treatmentconservative treatment 5 5 reimplantation in the aortareimplantation in the aorta 33 aortoaorto - - renal bypass renal bypass 22
Renal artery PTARenal artery PTA 2121Renal artery PTA plus stentRenal artery PTA plus stent 22
Final remarkFinal remarks:s:
Search for renovascular hypertension Search for renovascular hypertension in moderate and high risk suspicion;in moderate and high risk suspicion;
DoDo nnoot forget: renovascular hypertension is t forget: renovascular hypertension is fortunately fortunately aa curable form of hypertension! curable form of hypertension!
The advantages of conventional angiography areThe advantages of conventional angiography are::
morphological diagnosis – to be or not to bemorphological diagnosis – to be or not to be
functional assesment of physiological effects functional assesment of physiological effects of renal arteryof renal artery stenosisstenosis
direct and immediately treatment with direct and immediately treatment with interventionalinterventional procedure procedure
We are for an early direct contrast We are for an early direct contrast conventional angiographyconventional angiography!!