Renovascular Hypertension

Renovascular disease is one of the most common causes of secondary hypertension

  • Renovascular hypertension is difficult to manage medically.
  • Lesions in the renal arteries are progressive and may result in complete occlusion.
  • If not treated properly, it may result in end-stage renal disease.
  • High risk of cerebral and cardiovascular complications.
  • Renal revascularization can potentially cure or better control the hypertension.

Atherosclerosis is the most common cause of renal artery disease and accounts for 70% of all renal artery lesions. These lesions predominantly affect men over 50 years of age. The disease may be limited to the renal artery but is more often manifestation of diffuse atherosclerosis. Fibromuscular dysplasia of the renal arteries is the most common cause of renovascular hypertension in younger patients.


Laboratory and Diagnostic Evaluation

  • Digital substraction angiography
  • Plasma renin activity profile
  • Captopril challenge test
  • Renal vein renin sampling
  • Renal duplex ultrasonography
  • Magnetic resonance angiography
  • Spiral CT scans

Treatment

Surgical revascularization has been demonstrated to be effective in terms of both improved blood pressure control and stabilization of renal function.

  • Percutaneous transluminal procedure of angioplasty is the choice in most of the patients.
  • Renal artery stents.
  • Surgical reconstruction.
  • Unilateral nephrectomy.

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