Renovascular hypertension

Renovascular hypertension is a condition in which high blood pressure is caused by the kidneys' hormonal response to narrowing of the arteries supplying the kidneys.[1] When functioning properly this hormonal axis regulates blood pressure. Due to low local blood flow, the kidneys mistakenly increase blood pressure of the entire circulatory system. It is a form of secondary hypertension - a form of hypertension whose cause is identifiable.[3][4]

Renovascular hypertension
Other namesRenal hypertension
3D rendered CT of abdominal aortic branches kidneys
SpecialtyCardiology, nephrology Edit this on Wikidata
SymptomsHigh BP,kidney dysfunction[1]
Risk factorsDiabetes, High cholesterol[1]
Diagnostic methodBlood and urine test[2]
TreatmentAntihypertensive, Stress reduction[1]

Signs and symptoms
Pulmonary edema

Symptoms of renovascular hypertension include the following:[1]

Cause

The cause of renovascular hypertension is consistent with any narrowing/blockage of blood supply to the renal organ (renal artery stenosis). As a consequence of this action the renal organs release hormones that indicate to the body to maintain a higher amount of sodium and water, which in turn causes blood pressure to rise. Factors that may contribute are: diabetes, high cholesterol and advanced age,[1] also of importance is that a unilateral condition is sufficient to cause renovascular hypertension.[5]

Pathogenesis
Angiotension converting enzyme

The pathogenesis of renovascular hypertension involves the narrowing of the arteries supplying the kidneys which causes a low perfusion pressure that is detected by the juxtaglomerular apparatus (via the macula densa cells, which act as baroreceptors; located on the afferent arteriole wall).[6] This leads to renin secretion that causes the angiotensinogen conversion to angiotensin I. Angiotensin I then proceeds to the lung where it is converted to angiotensin II via angiotensin converting enzyme (ACE).[7]

In most people fibromuscular dysplasia or atherosclerosis is the reason for the occlusion of a renal artery which ultimately leads to this condition.[8]

Diagnosis

The diagnosis for renovascular hypertension is done by:[2]

Treatment

In terms of treatment for renovascular hypertension surgical revascularization versus medical therapy for atherosclerosis, it is not clear if one option is better than the other according to a 2014 Cochrane review; balloon angioplasty did show a small improvement in blood pressure .[9]

Surgery can include percutaneous surgical revascularization, and also nephrectomy or autotransplantation, and the individual may be given beta-adrenergic blockers.[10] Early therapeutic intervention is important if ischemic nephropathy is to be prevented. Inpatient care is necessary for the management of hypertensive urgencies, quick intervention is required to prevent further damage to the kidneys.[11]

Prognosis

The prognosis of individuals with renovascular hypertension is not easy to determine. Those with atherosclerotic renal artery disease have a high risk of mortality, furthermore, those who also have renal dysfunction have a higher mortality risk. However, the majority of renovascular diseases can be improved with surgery.[4]

See also

References
  1. MedlinePlus Encyclopedia: Renovascular hypertension
  2. "Renovascular Disease. Learn about Renovascular Disease | Patient". Patient. Retrieved 2015-09-30.
  3. Textor, Stephen C. (2014). "Secondary hypertension". Journal of the American Society of Hypertension. 8 (12): 943–5. doi:10.1016/j.jash.2014.10.007. PMID 25492839. – via ScienceDirect (Subscription may be required or content may be available in libraries.)
  4. Renovascular Hypertension at eMedicine
  5. Antman, Elliott M. (2007-01-01). Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease. Elsevier Health Sciences. p. 615. ISBN 978-1416033585.
  6. Rosenthal, J.; Arlart, I.; Franz, H. E. (2012). "Renovascular Hypertention". In Rosenthal, Julian (ed.). Arterial Hypertension: Pathogenesis, Diagnosis, and Therapy. Springer. pp. 201–202. ISBN 978-1-4612-5657-1.
  7. Dobrek L. An Outline of Renal Artery Stenosis Pathophysiology-A Narrative Review. Life (Basel). 2021;11(3):208. Published 2021 Mar 7. doi:10.3390/life11030208
  8. Lip, Gregory Y. H.; Hall, John E. (2007-06-28). Comprehensive Hypertension. Elsevier Health Sciences. p. 101. ISBN 9780323070676.
  9. Jenks, Sara; Yeoh, Su Ern; Conway, Bryan R; Jenks, Sara (2014). "Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis". The Cochrane Database of Systematic Reviews. 12 (12): CD002944. doi:10.1002/14651858.CD002944.pub2. PMC 7138037. PMID 25478936.
  10. Illustrated Manual of Nursing Practice. Lippincott Williams & Wilkins. 2002-01-01. p. 638. ISBN 9781582550824.
  11. Renovascular Hypertension~treatment at eMedicine

Further reading
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