hypertensive and ischemic nephropaties, renovascular diseases
DESCRIPTION
Zehra Eren, M.D. Hypertensive and ischemic nephropaties, renovascular diseases. LEARNING OBJECTIVES. explain hypertansion and renal disease interaction, describe renovascular diseases describe diagnostic evaluation explan therapy in renovascular deseases - PowerPoint PPT PresentationTRANSCRIPT
Zehra Eren, M.D.
• explain hypertansion and renal disease interaction,
• describe renovascular diseases
• describe diagnostic evaluation
• explan therapy in renovascular deseases
• describe and manage renal artery and vein
thrombosis
• explain microvascular renal diseases
Asemptomatic ‘’İncidental Renal Artery Stenosis’’
Renovascular Hypertension
İschemic Nephropathy
Accelerated CV Disease
-Congestive heart failure
-Stroke
-Secondary aldosteronism
Asemptomatic ‘’İncidental Renal Artery Stenosis (RAS)’’
Renovascular Hypertension
İschemic Nephropathy
Accelerated CV Disease
-Congestive heart failure
-Stroke
-Secondary aldosteronism
Some degree of RAS can be identified in 20%-
45% of patients undergoing vascular imaging
Most of these stenoses are of little or no
hemodynamic significance
Asemptomatic ‘’İncidental Renal Artery Stenosis (RAS)’’
Renovascular Hypertension
İschemic Nephropathy Accelerated CV Disease
-Congestive heart failure-Stroke-Secondary aldosteronism
Reduced renal perfusion
Rise in arterial pressure
Diagnosis is established only in retrospect after
succesful reversal of HT with revascularization
3%-5%, F>M
Medial fibroplasia is the most common
Location: midportion of the vessel
Smoking is a risk factor for progression
Most common renovascular lesion (75% - 84%)
Location: origin of artery
Associated with HT, DM, HPL, smoking, abnormal renal function
Asemptomatic ‘’İncidental Renal Artery Stenosis’’
Renovascular Hypertension
İschemic Nephropathy
Accelerated CV Disease
-Congestive heart failure
-Stroke
-Secondary aldosteronism
Establish presence of RAS: location and type of lesion
Establish whether unilateral or bilateral stenosis (or stenosis to a solitary kidney)
Establish presence and function of stenotic and nonstenotic kidneys
Establish hemodynamic severity of renal arteral disease
Plan vascular intervention
Physiologic and functional studies of the Renin-Angiotensin system
-plasma renin levels
-measurement of renal vein renin levels
Noninvasive imaging and assesment of the renal vasculature
-Doppler USG
-radyonuclide imaging
-magnetic resonance arteriography
-computed tomographic angiography
Improved BP
Prevent morbidity and mortality
Preservation of renal function
Medical therapy
Surgical therapy
-angioplasty
-angioplasty and stent replacement
Hemolytic- Uremic Syndrome (HUS)
Thrombotic- Thrombocytopenic Purpura (TTP)
Microangiopathic hemolytic anemia
Thrombocytopenic purpura
Acute renal failure
Fever
Neurologic dysfunction