Renovascular hypertension 3186310 225949286 2008-07-16T04:14:02Z Bunnyhop11 7345738 {{Infobox_Disease | Name = Renovascular hypertension | Image = | Caption = | DiseasesDB = | ICD10 = {{ICD10|I|15|0|i|10}} | ICD9 = {{ICD9|403}} | ICDO = | OMIM = | MedlinePlus = 000204 | eMedicineSubj = med | eMedicineTopic = 2006 | MeshID = D006978 | }} '''Renovascular hypertension''' (or "renal [[hypertension]]") is a [[syndrome]] which consists of high [[blood pressure]] caused by narrowing of the [[renal arteries|arteries supplying the kidneys]] ([[renal artery stenosis]]). It is a form of [[secondary hypertension]] - a form of hypertension whose cause is identifiable. Techniques have been developed to diagnose renal hypertension using [[digital image processing]] of [[radiograph]]s. Treatment may involve [[angioplasty]] and [[stent]]ing of the renal arteries. The syndrome may be related to other diseases of the [[epithelium]]. Suggestive clinical features include onset of hypertension <30 or >50 years of age, abdominal or femoral bruits, hypokalemic alkalosis, moderate to severe retinopathy, acute onset of hypertension or malignant hypertension, and hypertension resistant to medical therapy. Renal hypoperfusion activates renin-angiotensin-aldosterone ([[RAA]]) axis; [[ACE inhibitor]]s and [[ARB]] classes of [[antihypertensives]] are contraindicated as they might compromise the renal function especially if the Stenosis is bilateral. Nitroprusside, labetalol, or calcium antagonists are generally effective in lowering bp acutely, although inhibitors of the RAA axis [e.g., ACE inhibitors, angiotensin II receptor blockers (ARBs)] are most effective long-term treatment, if disease is not bilateral. The "gold standard" in diagnosis of renal artery stenosis is conventional arteriography. [[Magnetic resonance angiography]] (MRA) is used in many centers, especially among pts with renal insufficiency at higher risk for contrast nephropathy. MRA may overestimate the severity of stenosis relative to angiography. In pts with normal renal function and hypertension, the captopril (or enalaprilat) renogram may be used. Lateralization of renal function [accentuation of the difference between affected and unaffected (or "less affected") sides] is suggestive of significant vascular disease. Test results may be falsely negative in the presence of bilateral disease. Surgical revascularization appears to be superior for ostial lesions characteristic of atherosclerosis. The relative efficacy of surgery compared with angioplasty (especially with stenting) for fibromuscular dysplasia or for nonocclusive, nonostial atherosclerotic disease is unclear. Angioplasty (with or without stenting) tends to be most effective for mid-vessel or more distal lesions. No studies have adequately compared revascularization with medical therapy. ACE inhibitors or ARBs are ideal agents for hypertension associated with renal artery stenosis, except in pts with bilateral disease (see "Ischemic Nephropathy," below) or disease in a solitary kidney (including an allograft). Source: Harrison's Manual of Medicine: Renovascular Disease - Renal Artery Stenosis ==See also== * [[Hypertensive nephropathy]] * [[Renal artery stenosis]] * [[Renal failure]] ==External links== * [http://www.hmc.psu.edu/healthinfo/r/renovascularhypertension.htm PSU] {{Vascular diseases}} [[Category:Nephrology]] [[Category:Blood pressure]] {{disease-stub}} [[es:Hipertensión renovascular]]