renovascular hypertension or kidney failure due to hypertension

1. Kidney Failure in Hypertension
Yousaf Khan
Renal Dialysis Lecturer
IPMS-KMU

2. BLOOD PRESSURE
• Blood pressure is the force of
blood pushing against blood
vessel walls as the heart pumps
out blood.
• increase in the amount of force
that blood places on blood
vessels as it moves through the
body.
• Factors that can increase this
force include higher blood
volume due to extra fluid in the
blood and blood vessels that are
narrow, stiff, or clogged.

3. Stages of HTN
• Systolic pressure and represents the pressure as the heart beats and
pushes blood through the blood vessels.
• Diastolic pressure and represents the pressure as blood vessels relax
between heartbeats.

4. Renal Hypertension
• Also called Renovascular hypertension
• High blood pressure (hypertension ) is a leading cause of kidney disease
and kidney failure (end-stage renal disease).
• Hypertension can cause damage to the blood vessels and filters in the
kidney, making removal of waste from the body difficult. Once a person is
diagnosed with end-stage renal disease, dialysis -- a blood-cleansing
process -- or kidney transplantation are necessary.

5. Renovascular HTN
• Incidence 1-30%
• Etiology
– Atherosclerosis 75-90%
– Fibromuscular dysplasia 10-25%
– Other
• Aortic/renal dissection
• Thrombotic/cholesterol emboli
• CVD
• Post transplantation stenosis
• Post radiation

6. Causes of Renal Hypertension
• Narrowing in the arteries that deliver blood –Renal artery stenosis
• The narrowing in one or both renal arteries is most often caused by
atherosclerosis, or hardening of the arteries. This is the same process that
leads to many heart attacks and strokes.
• fibromuscular dysplasia
• Dehydration- releasing hormones that stimulate the body to retain sodium
and water. Blood vessels fill with additional fluid, and blood pressure goes
up.

7. Renovascular HTN - Pathophysiology
• Decrease in renal perfusion pressure activates RAAS, renin release
converts angiotensinogen Ang I; ACE converts Ang I Ang II
• Ang II causes vasoconstriction (among other effects) which causes HTN
and enhances adrenal release of aldosterone; leads to sodium and fluid
retention
• Contralateral kidney (if unilateral RAS) responds with diuresis/ Na, H2O
excretion which can return plasma volume to normal
• with sustained HTN, plasma renin activity decreases (limited usefulness
for dx
• Bilateral RAS or solitary kidney RAS leads to rapid volume expansion and
ultimate decline in renin secretion

8. Symptoms of Renal Hypertension
• In rare cases, high blood pressure can cause headaches.
• Kidney disease also does not have symptoms in the early stages. A person
may have swelling called edema, which happens when the kidneys cannot
get rid of extra fluid and salt. Edema can occur in the legs, feet, or ankles
and less often in the hands or face. Once kidney function decreases
further, symptoms can include
• Appetite loss
• nausea
• vomiting
• drowsiness or feeling tired
• trouble concentrating
• sleep problems
• increased or decreased urination
• generalized itching or numbness
dry skin
headaches
weight loss
darkened skin
muscle cramps
shortness of breath
chest pain

9. Diagnosis
• The diagnosis for renovascular hypertension is done by:
Blood test
• eGFR of 60 or above is in the normal range
• eGFR below 60 may indicate kidney damage
• eGFR of 15 or below may indicate kidney failure
• Urinary test (tests for microalbuminuria)
• Urinalysis (to exclude presence of red blood cells)
• et Screened for Kidney Disease
• Kidney disease, when found early, can be treated to prevent more serious
disease and other complications. The National Kidney Foundation
recommends people with high blood pressure receive the following
regular screenings:
• blood pressure tests
• urine albumin
• eGFR

10. Prevent Kidney Disease
• To prevent kidney damage from high blood pressure:
• Try to keep your blood pressure controlled.
• Make sure you get your blood pressure checked on a regular basis.
• Eat a proper diet.
• Get moderate exercise, such as walking, 30 minutes daily.
• Take the medication your doctor prescribes.
• healthy eating
• physical activity
• maintaining a healthy weight
• quitting smoking
• managing stress

11. Kidney Disease Treated?
• For patients who have high blood pressure and kidney disease, the most
important treatment is to control your blood pressure through lifestyle
changes.
• ACE inhibitor (lisinopril, captopril, benazepril, ramipril ) and angiotensin II
receptor blocker (ARB) (valsartan, losartan, candesartan, and olmesartan)
drugs lower blood pressure and can protect the kidneys from further
damage, but treatments needs to be individualized.
• Revascularization versus medical therapy for atherosclerosis,

12. Thank you