Zehra Eren, M.D.
Dec 19, 2015
• explain hypertansion and renal disease interaction,
• describe renovascular diseases
• describe diagnostic evaluation
• explan therapy in renovascular deseases
• describe and manage renal artery and vein
thrombosis
• explain microvascular renal diseases
Asemptomatic ‘’İncidental Renal Artery Stenosis’’
Renovascular Hypertension
İschemic Nephropathy
Accelerated CV Disease
-Congestive heart failure
-Stroke
-Secondary aldosteronism
Asemptomatic ‘’İncidental Renal Artery Stenosis (RAS)’’
Renovascular Hypertension
İschemic Nephropathy
Accelerated CV Disease
-Congestive heart failure
-Stroke
-Secondary aldosteronism
Some degree of RAS can be identified in 20%-
45% of patients undergoing vascular imaging
Most of these stenoses are of little or no
hemodynamic significance
Asemptomatic ‘’İncidental Renal Artery Stenosis (RAS)’’
Renovascular Hypertension
İschemic Nephropathy Accelerated CV Disease
-Congestive heart failure-Stroke-Secondary aldosteronism
Reduced renal perfusion
Rise in arterial pressure
Diagnosis is established only in retrospect after
succesful reversal of HT with revascularization
3%-5%, F>M
Medial fibroplasia is the most common
Location: midportion of the vessel
Smoking is a risk factor for progression
Most common renovascular lesion (75% - 84%)
Location: origin of artery
Associated with HT, DM, HPL, smoking, abnormal renal function
Asemptomatic ‘’İncidental Renal Artery Stenosis’’
Renovascular Hypertension
İschemic Nephropathy
Accelerated CV Disease
-Congestive heart failure
-Stroke
-Secondary aldosteronism
Establish presence of RAS: location and type of lesion
Establish whether unilateral or bilateral stenosis (or stenosis to a solitary kidney)
Establish presence and function of stenotic and nonstenotic kidneys
Establish hemodynamic severity of renal arteral disease
Plan vascular intervention
Physiologic and functional studies of the Renin-Angiotensin system
-plasma renin levels
-measurement of renal vein renin levels
Noninvasive imaging and assesment of the renal vasculature
-Doppler USG
-radyonuclide imaging
-magnetic resonance arteriography
-computed tomographic angiography
Microangiopathic hemolytic anemia
Thrombocytopenic purpura
Acute renal failure
Fever
Neurologic dysfunction