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Endocrinology and Metabolism Clinics of... Dec 2019Renovascular disease (RVD) is a major cause of secondary hypertension. Atherosclerotic renal artery stenosis is the most common type of RVD followed by fibromuscular... (Review)
Review
Renovascular disease (RVD) is a major cause of secondary hypertension. Atherosclerotic renal artery stenosis is the most common type of RVD followed by fibromuscular dysplasia. It has long been recognized as the prototype of angiotensin-dependent hypertension. However, the mechanisms underlying the physiopathology of hypertensive occlusive vascular renal disease are complex and distinction between the different causes of RVD should be made. Recognition of these distinct types of RVD with different degrees of renal occlusive disease is important for management. The greatest challenge is to individualize and implement the best approach for each patient in the setting of widely different comorbidities.
Topics: Fibromuscular Dysplasia; Humans; Hypertension, Renal; Hypertension, Renovascular; Nephritis; Renal Artery Obstruction
PubMed: 31655775
DOI: 10.1016/j.ecl.2019.08.007 -
Journal of the American Heart... Sep 2022
Topics: Humans; Hypertension, Renovascular; Nephrectomy; Renal Artery Obstruction
PubMed: 35975744
DOI: 10.1161/JAHA.122.025900 -
Revista Portuguesa de Cardiologia Dec 2019
Topics: Atherosclerosis; Constriction, Pathologic; Humans; Hypertension, Renovascular; Kidney; Stents
PubMed: 32139201
DOI: 10.1016/j.repc.2020.02.002 -
American Journal of Physiology. Renal... Aug 2015Obesity remains a prominent public health concern. Obesity not only contributes greatly to cardiovascular events but has also been identified to initiate and affect the... (Review)
Review
Obesity remains a prominent public health concern. Obesity not only contributes greatly to cardiovascular events but has also been identified to initiate and affect the progression of preexisting chronic kidney disease. The prevalence of renal artery stenosis is growing world-wide, especially in the elderly population and in individuals with atherosclerotic risk factors such as obesity. Prolonged renovascular disease causes inflammation and microvascular remodeling within the post-stenotic kidney, which promote tissue scarring and may account for irreversible renal damage. Obesity has been shown to aggravate kidney damage via several pathways, including exacerbation of microvascular regression and renal cell injury mediated by adipocytes and insulin resistance, thereby worsening the structural and functional outcomes of the kidney in renovascular disease. Dietary modification and inhibition of the renin-angiotensin-aldosterone system have been shown to alleviate obesity-induced tissue injury and remodeling. Possibly, angiogenic factors may boost microvascular repair in the ischemic kidney in the obesity milieu. Novel therapeutic interventions targeting deleterious pathways that are activated by obesity and responsible for kidney damage need to be explored in future studies.
Topics: Angiogenic Proteins; Animals; Hemodynamics; Humans; Hypertension, Renovascular; Microcirculation; Obesity; Prevalence; Prognosis; Renal Artery Obstruction; Renal Circulation; Renal Insufficiency, Chronic; Renin-Angiotensin System; Risk Assessment; Risk Factors; Signal Transduction
PubMed: 26041447
DOI: 10.1152/ajprenal.00547.2014 -
Current Problems in Surgery Feb 1985
Review
Topics: Angioplasty, Balloon; Arteriosclerosis; Blood Pressure; Blood Vessel Prosthesis; Endarterectomy; Fibromuscular Dysplasia; History, 19th Century; History, 20th Century; Humans; Hypertension, Renovascular; Ischemia; Kidney; Nephrectomy; Renal Artery; Renin-Angiotensin System; p-Aminohippuric Acid
PubMed: 3156729
DOI: 10.1016/0011-3840(85)90036-x -
Hypertension (Dallas, Tex. : 1979) Aug 2022Renovascular disease is a major causal factor for secondary hypertension and renal ischemic disease. However, several prospective, randomized trials for atherosclerotic... (Review)
Review
Renovascular disease is a major causal factor for secondary hypertension and renal ischemic disease. However, several prospective, randomized trials for atherosclerotic disease failed to demonstrate that renal revascularization is more effective than medical therapy for most patients. These results have greatly reduced the generalized diagnostic workup and use of renal revascularization. Most guidelines and review articles emphasize the limited average improvement and fail to identify those clinical populations that do benefit from revascularization. On the basis of the clinical experience of hypertension centers, specialists have continued selective revascularization, albeit without a summary statement by a major, multidisciplinary, national organization that identifies specific populations that may benefit. In this scientific statement for health care professionals and the public-at-large, we review the strengths and weaknesses of randomized trials in revascularization and highlight (1) when referral for consideration of diagnostic workup and therapy may be warranted, (2) the evidence/rationale for these selective scenarios, (3) interventional and surgical techniques for effective revascularization, and (4) areas of research with unmet need.
Topics: American Heart Association; Humans; Hypertension; Hypertension, Renovascular; Prospective Studies; Renal Artery Obstruction; Vascular Surgical Procedures
PubMed: 35708012
DOI: 10.1161/HYP.0000000000000217 -
European Heart Journal Jul 2011The diagnosis and management of patients with renovascular disease and hypertension continue to elude healthcare providers. The advent of novel imaging and... (Review)
Review
The diagnosis and management of patients with renovascular disease and hypertension continue to elude healthcare providers. The advent of novel imaging and interventional techniques, and increased understanding of the pathways leading to irreversible renal injury and renovascular hypertension, have ushered in commendable attempts to optimize and fine-tune strategies to preserve or restore renal function and control blood pressure. Large randomized clinical trials that compare different forms of therapy, and smaller trials that test novel experimental treatments, will hopefully help formulate innovative concepts and tools to manage the patient population with atherosclerotic renovascular disease.
Topics: Angiography, Digital Subtraction; Angioplasty, Balloon; Angiotensin Receptor Antagonists; Atherosclerosis; Drug-Eluting Stents; Early Diagnosis; Fibromuscular Dysplasia; Hemodynamics; Humans; Hypertension, Renovascular; Magnetic Resonance Imaging; Renal Artery Obstruction; Renin-Angiotensin System; Reperfusion; Tomography, X-Ray Computed; Ultrasonography, Doppler
PubMed: 21273200
DOI: 10.1093/eurheartj/ehq510 -
The American Journal of Nursing Feb 2000
Review
Topics: Angiotensin-Converting Enzyme Inhibitors; Humans; Hypertension, Renovascular
PubMed: 10683643
DOI: 10.1097/00000446-200002000-00046 -
Iranian Journal of Kidney Diseases Mar 2017Renovascular disease includes renal artery stenosis, renovascular hypertension, and azotemic renovascular disease (ischemic nephropathy). Renovascular hypertension is... (Review)
Review
Renovascular disease includes renal artery stenosis, renovascular hypertension, and azotemic renovascular disease (ischemic nephropathy). Renovascular hypertension is defined as an elevated blood pressure caused by renal hypoperfusion, usually resulting from anatomic stenosis of the renal artery and activation of the renin-angiotensin system. It accounts for 1% to 2 % of all cases of hypertension in the general population and 5.8 % of secondary hypertension, but it plays a major role in treatable causes of hypertension in the young individuals. Although renovascular stenosis is a common and progressive disease in patients with atherosclerosis, it is a relatively uncommon cause of hypertension in patients with mild hypertension. In contrast, renal artery stenosis is more frequent in certain high-risk populations. Early diagnosis of renovascular hypertension and timely implementation of appropriate therapeutic procedures ensures optimum control of blood pressure, prevents ischemic nephropathy progression, and prevents the development of cardiovascular morbidity and mortality in the hypertensive patient population. As with most complex disorders, management decisions must be highly individualized for patients with renovascular disease. It is essential to consider renal arterial disease as one aspect of atherosclerotic disease.
Topics: Early Diagnosis; Humans; Hypertension, Renovascular; Magnetic Resonance Imaging; Randomized Controlled Trials as Topic; Renal Artery; Renal Artery Obstruction; Renin; Renin-Angiotensin System; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color
PubMed: 28270639
DOI: No ID Found -
Indian Pediatrics Jan 2005Renovascular hypertension results from a lesion that impairs blood flow to a part or all, of one or both kidneys. 3-10% of children referred for the evaluation of severe... (Review)
Review
Renovascular hypertension results from a lesion that impairs blood flow to a part or all, of one or both kidneys. 3-10% of children referred for the evaluation of severe hypertension are subsequently found to have clinically significant renovascular lesions Renovascular hypertension is the second most common cause of correctable hypertension in children second only to coarctation of the aorta. Specific therapeutic options now available, justify the often-invasive investigations required to confirm the diagnosis of renovascular hypertension. A systematic evaluation of the child with hypertension will help the pediatrician select correctly, the child most likely to have renovascular hypertension, thus reducing the number of children exposed to the risks involved with diagnostic but invasive investigations like renal arteriography which remains the gold standard Other non-invasive newer modalities like doppler ultrasonography, computed duplex sonography, ACE inhibited radionuclide imaging, and MR/CT/spiral CT angiography may be used depending on the availability of the facilities. Definite therapeutic options for renal artery stenosis include angioplasty, stenting and surgical re-vascularization using a bypass graft.
Topics: Child; Humans; Hypertension, Renovascular; Magnetic Resonance Angiography; Radionuclide Imaging; Ultrasonography, Doppler
PubMed: 15695858
DOI: No ID Found