scholarly journals Understanding and managing atherosclerotic renovascular disease: still a work in progress

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1862
Author(s):  
Alejandro R. Chade
Keyword(s):  
Blood Pressure ◽  
Pressure Control ◽  
Current Treatment ◽  
Therapeutic Strategies ◽  
Renal Parenchyma ◽  
Renovascular Disease ◽  
Renal Angioplasty ◽  
Vascular Obstruction ◽  
Therapeutic Alternatives ◽  
Atherosclerotic Renovascular Disease

Atherosclerotic renovascular disease (ARVD) is an unresolved therapeutic dilemma despite extensive pre-clinical and clinical studies. The pathophysiology of the disease has been widely studied, and many factors that may be involved in progressive renal injury and cardiovascular risk associated with ARVD have been identified. However, therapies and clinical trials have focused largely on attempts to resolve renal artery stenosis without considering the potential need to treat the renal parenchyma beyond the obstruction. The results of these trials show a staggering consistence: although nearly 100% of the patients undergoing renal angioplasty show a resolution of the vascular obstruction, they do not achieve significant improvements in renal function or blood pressure control compared with those patients receiving medical treatment alone. It seems that we may need to take a step back and reconsider the pathophysiology of the disease in order to develop more effective therapeutic strategies. This mini-review discusses potential therapeutic alternatives that focus on the renal parenchyma distal to the vascular obstruction and may provide additional tools to enhance current treatment of ARVD.

Ischaemic nephropathy

2015 ◽  
Author(s):  
Helen Alderson ◽  
Constantina Chrysochou ◽  
James Ritchie ◽  
Philip A. Kalra
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Filtration Rate ◽  
Blood Pressure Reduction ◽  
Western World ◽  
Pressure Reduction ◽  
Renovascular Disease ◽  
Angiotensin Blockade ◽  
Atherosclerotic Renovascular Disease ◽  
Common Manifestation

Ischaemic nephropathy describes loss of renal function or renal parenchyma due to stenosis or occlusion of the renal artery or its branches. In the Western world, this is usually the result of atherosclerotic renovascular disease, but other aetiologies include arteritis, embolic disease, dissection, and fibromuscular disease.Chronic kidney disease is the most common manifestation of ischaemic nephropathy, but hypertension, flash pulmonary oedema, sensitivity to angiotensin blockade, and sensitivity of glomerular filtration rate to blood pressure reduction are all possible manifestations of occlusive diseases of the renal artery or its branches. Proteinuria may also occur.This chapter describes these clinical features and the outcomes of ischaemic nephropathy. It goes on to discuss the haemodynamics and mechanisms and what we understand of the pathophysiology of the condition.

scholarly journals P1806OUTCOMES OF PEDIATRIC RENOVASCULAR HYPERTENSON: A SINGLE-CENTER EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jiwon Jung ◽  
Joo Hoon Lee ◽  
Kun suk Kim ◽  
Young Seo Park
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Blood Pressure Control ◽  
Antihypertensive Agents ◽  
Good Control ◽  
Pressure Control ◽  
Renovascular Disease ◽  
Antihypertensive Medications

Abstract Background and Aims Renovascular disease is rare but important treatable cause of secondary hypertension in children. We aimed to evaluate the clinical presentations and long-term outcomes of pediatric patients with renovascular hypertension (RVH). Method We retrospectively reviewed medical records of patients with renovascular disease at our center between 1994 and 2019. Clinical courses including status of hypertension control with preservation of renal function during follow up were evaluated. Results 20 patients were diagnosed with RVH. 50 % (n = 10) were male, and median age at diagnosis was 10.1 (range 1.3 – 17.2) years, and median follow up period was 8.7 (range 0.1 – 24.6) years. 50 % (n = 10) presented with incidently detected high blood pressure (8 patients without symptoms, one with headache, and the other one with proteinuria), 25 % (n = 5) first admitted due to heart failure symptoms, and the rest (25 %, n = 5) presented with neurologic symptoms including seizure or paraplegia. Majority had no underlying disease except for 3 patients with Moyamoya disease. 80 % (n = 16) had unilateral renovascular stenosis. All patients showed elevated basal random renin activity (median 20.0, range 2.5 – 62.1 ng/ml/hr), and 45 % (n = 9) patients showed elevated basal random aldosterone level (median 822, range 266 – 2440 pg/ml). All patients needed antihypertensive medications for blood pressure control; 35 % (n = 7) of patients gained good control of blood pressure only with antihypertensive agents including angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), 40 % (n = 8) of patients who underwent percutaneous transluminal angioplasty all still needed antihypertensive agents including ACEI for blood pressure control. 20 % (n = 4) of the patients initially showed profoundly low relative function of involved kidney on diuretic scan, leading to nephrectomy. Three of these patients with nephrectomy successfully discontinued all antihypertensive agent gaining good control of blood pressure. The remaining one patient showed progressive deterioration of relative function on the involved side of kidney during 13 years, ended up with nephrectomy, but couldn’t discontinue ACEI. Glomerular filtration rate (GFR) was within normal range for all patients at diagnosis. For patients without nephrectomy, mean relative function of the involved kidney on diuretic scan was 33.5 ± 11.4 % at diagnosis. There was no significant change or deterioration of relative renal function during a mean follow up period of 10 ± 8 (median 11.5, range 0 – 19.5) years, although they all used ACEI/ARB. All patients including patients with nephrectomy showed normal GFR with a mean of 114.1 ± 19.5 ml/min/1.73 m2 at the last follow up. Conclusion Antihypertensive medications including ACEI and ARB were safely used with no further deterioration of the renal function of the involved side with or without angioplasty. Pediatric RVH is well managed with preserved renal function in long-term follow up.

Controlling Blood Pressure without Drugs – Developing New Strategies

2010 ◽  
Vol 6 (2) ◽  
pp. 18
Author(s):  
Markus P Schlaich ◽  
Murray D Esler ◽  
◽  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Therapeutic Strategies ◽  
Novel Device ◽  
Major Player ◽  
Treatment Of Hypertension ◽  
Sympathetic Nervous ◽  
Optimal Blood Pressure ◽  
New Strategies

Non-optimal blood pressure is the leading cause of death globally, and each year is responsible for seven million deaths. Current therapeutic strategies for hypertension are mainly based on lifestyle interventions and pharmacological approaches, but rates of blood pressure control remain unsatisfactory and additional options are required. In this context, novel device-based approaches specifically targeting the sympathetic nervous system as a major player in blood pressure control have recently been tested clinically with promising results. Device-based approaches may provide additional and more effective treatment of hypertension and its adverse consequences in the future.

Controlling Blood Pressure without Drugs – Developing New Strategies

2011 ◽  
Vol 3 (1) ◽  
pp. 37
Author(s):  
Markus P Schlaich ◽  
Murray D Esler ◽  
◽  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Therapeutic Strategies ◽  
Novel Device ◽  
Major Player ◽  
Treatment Of Hypertension ◽  
Sympathetic Nervous ◽  
Optimal Blood Pressure ◽  
New Strategies

Non-optimal blood pressure is the leading cause of cardiovascular-related death worldwide, and each year is responsible for seven million deaths. Current therapeutic strategies for hypertension are mainly based on lifestyle interventions and pharmacological approaches, but rates of blood pressure control remain unsatisfactory and additional options are required. In this context, novel device-based approaches specifically targeting the sympathetic nervous system as a major player in blood pressure control have recently been tested clinically with promising results. Device-based approaches may provide additional and more effective treatment of hypertension and its adverse consequences in the future.

scholarly journals Impact of Serum Uric Acid Levels on Outcomes following Renal Artery Revascularization in Patients with Renovascular Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Xiao-jun Chen ◽  
Alfonso Eirin ◽  
Garvan C. Kane ◽  
Sanjay Misra ◽  
Stephen C. Textor ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Uric Acid ◽  
Confidence Interval ◽  
Serum Uric Acid ◽  
Negative Impact ◽  
Multiple Logistic Regression Analysis ◽  
Left Ventricular ◽  
Renovascular Disease ◽  
Renal Angioplasty ◽  
Very High

Background. Percutaneous transluminal renal angioplasty (PTRA) improves blood pressure (BP) and renal function only in selected patients with atherosclerotic renovascular disease (ARVD). Hyperuricemia is associated with elevated risk for hypertension and chronic renal disease, but its role in renovascular hypertension is unclear. We hypothesized that hyperuricemia negatively impacts renal and BP outcomes among patients with ARVD undergoing PTRA. Methods. This retrospective, observational cohort study included 94 patients with ARVD and preserved systolic cardiac function, who underwent PTRA at Mayo Clinic, Rochester, Minnesota. Renal, BP, and mortality outcomes were compared among patients according to their serum uric acid (SUA) levels. Multivariate analysis was used to determine significant predictors of renal, BP, and mortality outcomes after PTRA. Results. Compared to patients with normal basal SUA levels (≤5.7 mg/dl), patients with very high SUA (≥8.7 mg/dl) had lower baseline estimated glomerular filtration rate (eGFR), more extensive use of antihypertensive and diuretic drugs, increased baseline systolic blood pressure (SBP), and elevated left ventricular mass index. After PTRA, multiple logistic regression analysis showed that, compared to normal SUA, very high SUA was associated with decreased odds ratio (OR) of change in eGFR (adjusted OR=0.90; 95% confidence interval [CI], 0.86-0.95), but not of change in SBP. In multivariate linear analysis SUA independently predicted delta urine protein/creatinine ratio (β: 26.0; 95% confidence interval, 13.9 to 38.1). Conclusion. Severe hyperuricemia in patients with AVRD may have a negative impact on outcomes of renal revascularization.

scholarly journals Resistant hypertension in atherosclerotic renovascular disease

2015 ◽  
Vol 4 (3S) ◽  
pp. 5-10
Author(s):  
Angelo Bosio ◽  
Flavio Cerrato ◽  
Claudio Pascale
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Resistant Hypertension ◽  
Therapeutic Strategies ◽  
Careful Evaluation ◽  
Renovascular Disease ◽  
Atherosclerotic Renal Artery Stenosis ◽  
Adequate Evaluation ◽  
The Right ◽  
Atherosclerotic Renovascular Disease

Resistant hypertension requires careful evaluation for cause assessment. In this report we present a case of renovascular hypertension due to atherosclerotic renal artery stenosis, with particular regard for diagnostic options and therapeutic strategies (medical therapy versus endovascular angioplasty). This case underlines the importance of an adequate evaluation of the patient’s characteristics (i.e age and comorbidities) in order to choose the right strategy.

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