Renovascular hypertension

Other names: Renal hypertension
3D rendered CT of abdominal aortic branches kidneys
Symptoms| High BP,kidney dysfunction[1]
Risk factors| Diabetes, High cholesterol[1]
Diagnostic method| Blood and urine test[2]
Treatment| Antihypertensive, Stress reduction[1]

Renovascular hypertension is a condition in which high blood pressure is caused by the kidneys' hormonal response to narrowing of the arteries supplying the kidneys.[1] When functioning properly this hormonal axis regulates blood pressure. Due to low local blood flow, the kidneys mistakenly increase blood pressure of the entire circulatory system. It is a form of secondary hypertension \- a form of hypertension whose cause is identifiable.[3][4]

## Contents

* 1 Signs and symptoms
* 2 Cause
* 3 Pathogenesis
* 4 Diagnosis
* 5 Treatment
* 6 Prognosis
* 7 See also
* 8 References
* 9 Further reading
* 10 External links

## Signs and symptoms[edit | edit source]

Symptoms of renovascular hypertension include the following:[1]

* High blood pressure (early age)
* Kidney dysfunction
* Narrowing of arteries elsewhere in the body
* Pulmonary edema

## Cause[edit | edit source]

The cause of renovascular hypertension is consistent with any narrowing/blockage of blood supply to the renal organ (renal artery stenosis). As a consequence of this action the renal organs release hormones that indicate to the body to maintain a higher amount of sodium and water, which in turn causes blood pressure to rise. Factors that may contribute are: diabetes, high cholesterol and advanced age,[1] also of importance is that a unilateral condition is sufficient to cause renovascular hypertension.[5]

## Pathogenesis[edit | edit source]

Angiotension converting enzyme

The pathogenesis of renovascular hypertension involves the narrowing of the arteries supplying the kidneys which causes a low perfusion pressure that is detected by the juxtaglomerular apparatus (via the macula densa cells, which act as baroreceptors; located on the afferent arteriole wall).[6] This leads to renin secretion that causes the angiotensinogen conversion to angiotensin I. Angiotensin I then proceeds to the lung where it is converted to angiotensin II via angiotensin converting enzyme (ACE).[7]

In most people fibromuscular dysplasia or atherosclerosis is the reason for the occlusion of a renal artery which ultimately leads to this condition.[8]

## Diagnosis[edit | edit source]

* Images a,b,c,d,e) (Malignant) renovascular hypertension caused by a renal artery CG (Chimney graft) occlusion

* Pulmonary edema

The diagnosis for renovascular hypertension is done by:[2]

* Blood test (for renal function)
* Urinary test (tests for microalbuminuria)
* Serology (to exclude systemic lupus erythematosus )
* Lipid profile
* Urinalysis (to exclude presence of red blood cells)
* Ultrasound
* MRI
* CT

## Treatment[edit | edit source]

In terms of treatment for renovascular hypertension surgical revascularization versus medical therapy for atherosclerosis, it is not clear if one option is better than the other according to a 2014 Cochrane review; balloon angioplasty did show a small improvement in blood pressure .[9]

Surgery can include percutaneous surgical revascularization, and also nephrectomy or autotransplantation, and the individual may be given beta-adrenergic blockers.[10] Early therapeutic intervention is important if ischemic nephropathy is to be prevented. Inpatient care is necessary for the management of hypertensive urgencies, quick intervention is required to prevent further damage to the kidneys.[11]

## Prognosis[edit | edit source]

The prognosis of individuals with renovascular hypertension is not easy to determine. Those with atherosclerotic renal artery disease have a high risk of mortality, furthermore, those who also have renal dysfunction have a higher mortality risk. However, the majority of renovascular diseases can be improved with surgery.[4]

## See also[edit | edit source]

* Fibromuscular dysplasia
* Hypertensive nephropathy
* Kidney failure
* Renal artery stenosis

## References[edit | edit source]

1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 MedlinePlus Encyclopedia: Renovascular hypertension
2. ↑ 2.0 2.1 "Renovascular Disease. Learn about Renovascular Disease | Patient". Patient. Archived from the original on 2016-03-04. Retrieved 2015-09-30.
3. ↑ Textor, Stephen C. (2014). "Secondary hypertension". Journal of the American Society of Hypertension. 8 (12): 943–5. doi:10.1016/j.jash.2014.10.007. PMID 25492839. – via ScienceDirect (Subscription may be required or content may be available in libraries.)
4. ↑ 4.0 4.1 Renovascular Hypertension at eMedicine
5. ↑ Antman, Elliott M. (2007-01-01). Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease. Elsevier Health Sciences. p. 615\. ISBN 978-1416033585. Archived from the original on 2016-05-05. Retrieved 2022-05-15.
6. ↑ Rosenthal, J.; Arlart, I.; Franz, H. E. (2012). "Renovascular Hypertention". In Rosenthal, Julian (ed.). Arterial Hypertension: Pathogenesis, Diagnosis, and Therapy. Springer. pp. 201–202. ISBN 978-1-4612-5657-1. Archived from the original on 2019-12-22. Retrieved 2022-05-15.
7. ↑ Dobrek L. An Outline of Renal Artery Stenosis Pathophysiology-A Narrative Review. Life (Basel). 2021;11(3):208. Published 2021 Mar 7. doi:10.3390/life11030208
8. ↑ Lip, Gregory Y. H.; Hall, John E. (2007-06-28). Comprehensive Hypertension. Elsevier Health Sciences. p. 101\. ISBN 9780323070676. Archived from the original on 2016-06-10. Retrieved 2022-05-15.
9. ↑ Jenks, Sara; Yeoh, Su Ern; Conway, Bryan R; Jenks, Sara (2014). "Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis". The Cochrane Database of Systematic Reviews. 12 (12): CD002944. doi:10.1002/14651858.CD002944.pub2. PMC 7138037. PMID 25478936.
10. ↑ Illustrated Manual of Nursing Practice. Lippincott Williams & Wilkins. 2002-01-01. p. 638. ISBN 9781582550824.
11. ↑ Renovascular Hypertension~treatment at eMedicine

## Further reading[edit | edit source]

* Advances in Renal Hypertension Research and Treatment: 2012 Edition: ScholarlyPaper. ScholarlyEditions. 2012-12-26. ISBN 9781481636018. Archived from the original on 2019-12-21. Retrieved 2022-05-15.
* Textor, Stephen C. (2009). "Current Approaches to Renovascular Hypertension". Medical Clinics of North America. 93 (3): 717–32, Table of Contents. doi:10.1016/j.mcna.2009.02.012. PMC 2752469. PMID 19427501.
* Mehta, Ankit N.; Fenves, Andrew (2010). "Current opinions in renovascular hypertension". Proceedings. 23 (3): 246–9. doi:10.1080/08998280.2010.11928627. PMC 2900976. PMID 20671820.

## External links[edit | edit source]

Classification|

* ICD-10: I15.0
* ICD-9-CM: 403
* MeSH: D006978

|

External resources|

* MedlinePlus: 000204
* eMedicine: med/2006

* v
* t
* e

Cardiovascular disease (vessels)

Arteries, arterioles
and capillaries|

| Inflammation|

* Arteritis
* Aortitis
* Buerger's disease

|

Peripheral artery disease|

| Arteriosclerosis|

* Atherosclerosis
* Foam cell
* Fatty streak
* Atheroma
* Intermittent claudication
* Critical limb ischemia

* Monckeberg's arteriosclerosis
* Arteriolosclerosis
* Hyaline
* Hyperplastic
* Cholesterol
* LDL
* Oxycholesterol
* Trans fat

|

Stenosis|

* Carotid artery stenosis
* Renal artery stenosis

Other|

* Aortoiliac occlusive disease
* Degos disease
* Erythromelalgia
* Fibromuscular dysplasia
* Raynaud's phenomenon

Aneurysm / dissection /
pseudoaneurysm|

* torso: Aortic aneurysm
* Abdominal aortic aneurysm
* Thoracic aortic aneurysm
* Aneurysm of sinus of Valsalva
* Aortic dissection
* Aortic rupture
* Coronary artery aneurysm
* head / neck
* Intracranial aneurysm
* Intracranial berry aneurysm
* Carotid artery dissection
* Vertebral artery dissection
* Familial aortic dissection

Vascular malformation|

* Arteriovenous fistula
* Arteriovenous malformation
* Telangiectasia
* Hereditary hemorrhagic telangiectasia

Vascular nevus|

* Cherry hemangioma
* Halo nevus
* Spider angioma

Veins|

| Inflammation|

* Phlebitis

|

Venous thrombosis /
Thrombophlebitis|

* primarily lower limb
* Deep vein thrombosis
* abdomen
* Hepatic veno-occlusive disease
* Budd–Chiari syndrome
* May–Thurner syndrome
* Portal vein thrombosis
* Renal vein thrombosis
* upper limb / torso
* Mondor's disease
* Paget–Schroetter disease
* head
* Cerebral venous sinus thrombosis
* Post-thrombotic syndrome

Varicose veins|

* Gastric varices
* Portacaval anastomosis
* Caput medusae
* Esophageal varices
* Hemorrhoid
* Varicocele

Other|

* Chronic venous insufficiency
* Chronic cerebrospinal venous insufficiency
* Superior vena cava syndrome
* Inferior vena cava syndrome
* Venous ulcer

Arteries or veins|

* Angiopathy
* Macroangiopathy
* Microangiopathy
* Embolism
* Pulmonary embolism
* Cholesterol embolism
* Paradoxical embolism
* Thrombosis
* Hepatic artery thrombosis
* Vasculitis

Blood pressure|

| Hypertension|

* Hypertensive heart disease
* Hypertensive emergency
* Hypertensive nephropathy
* Essential hypertension
* Secondary hypertension
* Renovascular hypertension
* Benign hypertension
* Pulmonary hypertension
* Systolic hypertension
* White coat hypertension

|

Hypotension|

* Orthostatic hypotension

* v
* t
* e

Kidney disease

Glomerular disease|

* See Template:Glomerular disease

Tubules|

* Renal tubular acidosis
* proximal
* distal
* Acute tubular necrosis
* Genetic
* Fanconi syndrome
* Bartter syndrome
* Gitelman syndrome
* Liddle's syndrome

Interstitium|

* Interstitial nephritis
* Pyelonephritis
* Balkan endemic nephropathy

Vascular|

* Renal artery stenosis
* Renal ischemia
* Hypertensive nephropathy
* Renovascular hypertension
* Renal cortical necrosis

General syndromes|

* Nephritis
* Nephrosis
* Renal failure
* Acute renal failure
* Chronic kidney disease
* Uremia

Other|

* Analgesic nephropathy
* Renal osteodystrophy
* Nephroptosis
* Abderhalden–Kaufmann–Lignac syndrome
* Diabetes insipidus
* Nephrogenic
* Renal papilla
* Renal papillary necrosis
* Major calyx/pelvis
* Hydronephrosis
* Pyonephrosis
* Reflux nephropathy

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