Renovascular hypertension is a renal hypertension, which develops in the presence of occlusion of the arteries of the kidneys. To cure disease the patient need to fully restore blood flow in these organs.
The causes of pathology
At the moment doctors found violations that can trigger the development of renovascular hypertension. Below are the most common:
- Atherosclerotic disease of the arteries. Pathology develops in male patients, whose age is in the range of 40-55 years.
- Fibromuscular dysplasia. This condition causes the development of artery stenosis. Pathology common in young people, whose age does not exceed 35 years. In women, the disease occurs 5 times more often. Experts believe that this condition is inborn.
- Takayasu's Disease. It is an autoimmune disease characterized by the development of allergic inflammation. As a result there is necrosis of the connective tissue, hyperplasia of the arterial walls. That gradually causes complete obliteration of the vascular.
- Panarteritis of the aorta. This disease can spread to the renal arteries. The disease occurs in girls aged 13-23 years. In some cases, developing kidney failure.
- Compression of the renal arteries. This can occur when the location within the vessel of a tumor, hematoma, aneurysm, cysts, as well as the abnormal development of the kidneys.
Signs of the disease
Symptoms of renovascular hypertension is determined by the cause of the disease. With the development of fibromuscular dysplasia in children is found stable hypertension. While diastolic blood pressure is greatly increased on the backdrop of a small magnitude pulse.
Atherosclerotic stenosis can lead to a sharp deterioration of arterial hypertension in elderly patients. This marked a violation of kidney function (reduction filter).
With a sharp increase azotemia in patients receiving ACE inhibitors the doctor should suspect the development of atherosclerotic stenosis of the vessel in the kidneys.
Renovascular hypertension is mainly characterized by heavy flow. Patients develop severe cardiac hypertrophy and retinopathy.
With bilateral renal artery stenosis in patients of advanced age there is swelling of the lungs to decompensation of the heart.
Fibromuscular the disease does not change the functionality of the kidneys, and violations can occur only whensevere form of the disease. For this pathology not characterized by the development of urinary symptoms, but in some cases, there is microalbuminuria, minor proteinuria.
Clinical signs allow to suspect development of the disease, but the doctor should not rely only on symptoms at the time of diagnosis.
As diagnostic procedures widely used x-ray, ultrasound, and nuclear medicine and radioimmunoassay methods, angiography.
The most informative and reliable method is selective angiography of the arteries of the kidneys. It is performed on the basis of a specialized vascular center.
The study will determine the cause of renovascular hypertension to assess the severity of stenosis of the vascular and the localization of the pathological process. The information necessary for decisions about surgery.
Conservative therapy of the disease
The treatment is to reduce blood pressure, as well as the likelihood of renal failure and disorders of the heart.
In the treatment of atherosclerotic stenosis, which can lead to coronary heart disease, it is necessary to take measures to nephroprotective and reduce the level of lipids in the blood (use statins).
In the conservative treatment of a special place should be given diet which is to reduce salt intake (no more than 3 grams per day) and the normalization of lipid metabolism, purine bases, carbohydrates.
The patient also need to abandon Smoking and drinking alkogolsoderzhaschih drinks. Such measures will significantly reduce the likelihood of serious abnormalities of the heart and blood vascular.
To lower blood pressure prescribed ACE inhibitors and blockers angiotenzinovyh receptors. These drugs are very effective in the initial stages fibromuscular dysplasia.
For the treatment of moderate unilateral atherosclerotic stenosis prescribers due to the anti-atherogenic and cardioprotective effect.
With care, these groups of drugs used in patients with atherosclerotic stenosis, which is characterized by rapid narrowing of the artery.
For betonnogo treatment with ACE inhibitors necessary to control the concentration of creatinine and potassium in the blood every 5-6 months. Often monotherapy is not giving the desired effect, so also must the appointment beta-blockers, diuretics, agonists imidazole receptors. Heavyform of the disease may require the use of 5 different pharmacological groups of drugs.
To surgery is resorted to in case of inefficiency of conservative treatment and a high likelihood of side effects. However, the technical success of the operation is not in all cases, yields positive clinical results. Surgical therapy involves percutaneous balloon angioplasty or open surgery.
The first method involves "stretching" the affected area with the help of a catheter that has a small spray. To access the affected vessel made use of the femoral artery.
Advantages of percutaneous procedures:
- A smaller amount of interference;
- No need to use anesthesia.
However, balloon angioplasty may lead to rupture of blood vascular, hemorrhage, rupture of an unstable plaque with the development of embolism. But after angiosurgical major centres note that the risk of the listed complications is low.
Percutaneous angioplasty cannot be performed while the location of the stenosis at the mouth of the renal arteries or with complete occlusion. In such cases, conducting an open plasticity of the affected vessel.
This manipulation is to remove the affected area of the artery with plaques, followed by its reconstruction using the large veins of the patient.
The prognosis of the disease
Renovascular hypertension can lead to serious pathologies of the organs of the cardiovascular system. So, for most patients the prognosis is poor. However, early diagnosis, timely medical intervention drastically affect the development of the pathological process.