Reno vascular Hypertension

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My talk to the Department of Urology and Urology residents. A surgically catered talk on Renal Artery Stenosis.

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  • Flash pulm edema due to diastolic dysfunction due to htn/ras and fluid overload due to B RAS
  • 108 patients with suspected RAS and gave ACE watched creatinine and then later angiography
  • >50% severe
  • B after captopril with L RAS Following a bolus IV injection of an agent such as MAG3 that is secreated by the proximal tubule of the kidney, there is an increase in counts over the kidney reflecting arrival of the marker at the kidney, uptake into proximal tubule cells and secretion into tubular fluid. The peak Tmax is followed by an exponential decline as more tracer is eliminated into the urine than is concentrated in proximal tubules or secreted into the tubular lumen. The effect of an ACEI on a kidney downstream from a functional stenosis is to delay the time to maximum appearance and to delay the washout phase leading to an increase in RCA.
  • Gadolinium-enhanced MRA Sensitivities 100% Specificity 97%
  • Angiogram Gold standard. RAS >70% with pressure gradient greater than 30mmHg.
  • At baseline 19% normal, 33% <60, 48% >60
  • 3987 drive by shootings
  • Bottom line baseline abnormalities in renal function are related to extent of renal parencymal injury more than to degree of RAS
  • HTN CKD Survival
  • Is the stenosis the problem The degree of stenosis should correlate with the clinical sequale Heart and Kidney are different. Hyperfiltration. Urine is work. Blood is food. Is it protective?
  • Emma no difference in bp but 1 less medication
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