BY
ASOGWA INNOCENT KINGSLEY
ML-508
Anatomy of Kidney
Renal Vasculature
 a. Renalis, branches off from abdominal aorta, just below superior

mesenteric artery
Renal Physiology
Etiology Of Vasorenal Hypertension
 Congenital







Fibromuscular dysplasia( common)
Atresia
Hypoplasia of renal ...
Fibromuscular dysplasia
 Congenital disease
 Affects women more frequently
 Commonest cause of renovascular

hypertensi...
Atherosclerosis
Pathogenesis Vasorenal Hypertension
 Decrease in Renal blood flow stimulates juxtaglomerular








apparatus – incr...
Clinical Symptoms
 Complaints of high blood pressure

- headache( particularly at the back of the head and in the
morning...
Diagnosis
 Anamnesis
 Hypertension
 Pain in loins and lower back

 Auscultation

-murmur(abdominal bruits) on inferior...
Doppler US of Renal Artery

http://www.gehealthcare.com/usen/ultrasound/education/products/cme_ren_art.html#6
Angiography

 Severe renal artery stenosis, diagnosis confirmed by following

angiography



http://www.bmj.com/content/...
Differential Diagnosis
 Pheochromocytoma
 Cushing’s Disease

 Con’s Syndrome
 Thyroid Diseases
Conservative Treatment
Indicated for old patients with systemic vascular pathology
 Treatment of hypertension
 Enalapril...
Surgical Treatment
 Thrombendarterectomy with patch graft

 Renal artery bypass surgery
 Nephrectomy
Thrombendarterectomy
with Patch graft
Renal artery bypass surgery
Endovascular Treatment
 Percutaneous transluminal angioplasty (Balloon angioplasty)

 Placement of Stent
Complications
 Hemorrhage
 Infection
 Early and Late Thrombosis of Stent

 Occlusion, dissection and perforation of re...
Prognosis
 Untreated:
 Severe hypertension with damage to cardiovascular system
 Bilateral renal failure
 Intoxication...
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Chronic vascular diseases (vasorenal hypertension)

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Chronic vascular diseases (vasorenal hypertension)

  1. 1. BY ASOGWA INNOCENT KINGSLEY ML-508
  2. 2. Anatomy of Kidney
  3. 3. Renal Vasculature  a. Renalis, branches off from abdominal aorta, just below superior mesenteric artery
  4. 4. Renal Physiology
  5. 5. Etiology Of Vasorenal Hypertension  Congenital       Fibromuscular dysplasia( common) Atresia Hypoplasia of renal artery Angioma Aneurysm Arteriovenous fistula  Acquired       Atherosclerosis(common) Nonspecific aortoarteritis Nephroptosis Thrombosis and Embolism Trauma Tumour
  6. 6. Fibromuscular dysplasia  Congenital disease  Affects women more frequently  Commonest cause of renovascular hypertension among young patients  Degenerative disease affecting Tunica intima and Tunica Media of arteries  Multiple stenosis with intermittened dilatation of the artery  Common cause of aneurysm in smaller branches of renal artery
  7. 7. Atherosclerosis
  8. 8. Pathogenesis Vasorenal Hypertension  Decrease in Renal blood flow stimulates juxtaglomerular     apparatus – increase Renin secretion Increased renin causes conversion of angiotensinogen to angiotensin 1 and then to angiotensin 2 Acting on the vessels causing vasoconstriction and acting on the adrenal cortex, releasing aldosterone Increased Sodiun and water retension therefroe increasing extracellular fluid causing leg edema and increased blood pressure. Reduced glomerular filtration, Atrophy of affected kidney, renal failure, Hypertrophy of the contralateral kidney, Development of atherosclerosis of the contralateral renal artery
  9. 9. Clinical Symptoms  Complaints of high blood pressure - headache( particularly at the back of the head and in the morning), dizziness, tinnitus( buzzing or hissing in the ear), vertigo, altered vision or fainting episodes, palpitation, chest pains  Decreased renal function  Concommitent disturbances in other arterial beds - Pain in lower and upper extremities etc.
  10. 10. Diagnosis  Anamnesis  Hypertension  Pain in loins and lower back  Auscultation -murmur(abdominal bruits) on inferior costal margin of affected side  Doppler ultrasonography  Renography (isotope method)  Angiography
  11. 11. Doppler US of Renal Artery http://www.gehealthcare.com/usen/ultrasound/education/products/cme_ren_art.html#6
  12. 12. Angiography  Severe renal artery stenosis, diagnosis confirmed by following angiography  http://www.bmj.com/content/320/7242/1124.full
  13. 13. Differential Diagnosis  Pheochromocytoma  Cushing’s Disease  Con’s Syndrome  Thyroid Diseases
  14. 14. Conservative Treatment Indicated for old patients with systemic vascular pathology  Treatment of hypertension  Enalapril 20mg/day (ACE-inhibitor)  Hydrochlorothiazide 12.5 mg/day  Treatment of Acute Thrombosis  rt-PA (Alteplas)  Prophylaxis of thrombosis  Aspirin 75 mg daily  (Clopidogrel 75 mg daily combined with Aspirin)  Simvastatin 20mg/day (esp. Indicated for obese ptnt.)
  15. 15. Surgical Treatment  Thrombendarterectomy with patch graft  Renal artery bypass surgery  Nephrectomy
  16. 16. Thrombendarterectomy with Patch graft
  17. 17. Renal artery bypass surgery
  18. 18. Endovascular Treatment  Percutaneous transluminal angioplasty (Balloon angioplasty)  Placement of Stent
  19. 19. Complications  Hemorrhage  Infection  Early and Late Thrombosis of Stent  Occlusion, dissection and perforation of renal artery  Contrast nephrotoxicity
  20. 20. Prognosis  Untreated:  Severe hypertension with damage to cardiovascular system  Bilateral renal failure  Intoxication, Encephalopathy, Coma, Death  Treated (Depends on the duration of pathology and level of organ damage)  Focal disease i.e. Atherosclerotic disease limited to one renal artery; good prognosis with lowered arterial blood pressure and decreased antihypertensive medication.  Diffuse generalised atherosclerosis with secondary damages to kidney and other organs; poor prognosis with risk of developing firther organ damage.

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