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Diabetic Nephropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Glomerular hypertension is caused by the complications of diabetes mellitus, chronic glomerulonephritis (including focal segmental glomerular sclerosis), and IgA nephropathy. Renal artery stenosis is a narrowing of the arteries that deliver blood to the kidneys. Causative factors include altered tubuloglomerular feedback changes and activation of vasoactive mediators (nitric oxide, the renin-angiotensin system, protein kinase C, and endothelins), which increase glomerular capillary pressure and secondary GFR. With chronic glomerulonephritis, glomerular hypertension is mostly dependent upon blood volume, and not related to deteriorated kidney function. Renal parenchymal hypertension develops along with diabetic nephropathy, acute or chronic glomerulonephritis, hypertensive nephrosclerosis, polycystic kidney disease, and renal microvascular disorders. Glomerular hypertension has also been linked to sickle cell disease, hyperaldosteronism, pregnancy, obesity, and metabolic syndrome.
Complications of endovascular therapy for occlusive disease of splanchnic arteries including renal arteries
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Robert G. Molnar, Collin Gandillon
The diagnosis of severe renal and mesenteric artery stenosis is fully covered in the previous chapter dedicated to the identification and treatment of these vascular beds. The diagnostic approach can, however, aid in developing a safe and effective endovascular approach that can limit potential complications. The first test to be considered should be a duplex evaluation as this test can often rule in or rule out hemodynamically significant occlusive disease. Skilled vascular technologists in certified vascular laboratories are best suited to evaluate both renal and mesenteric occlusive disease processes. Many patients with CMI will have had multiple previous tests as the diagnosis of CMI requires a high index of suspicion. These patients might have seen a number of physicians who had formulated a varied differential diagnosis with ancillary testing but did not include vascular insufficiency on their lists of potential diagnoses. Renal artery stenosis is frequently evaluated in patients with refractory hypertension as well as renal insufficiency.
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Pseudoaneurysm is possible following trauma; however, these would be more common follow a laceration. Renal artery stenosis would be unlikely to acutely develop in this clinical setting. Renal vein thrombosis is more common in transplant kidneys than native kidneys and the forward flow in diastole on the arterial trace is reassuring. The lack of hydronephrosis and the clinical history makes ureteric obstruction unlikely.
Characteristics and predictors of low-grade renal artery stenosis in female patients with CKD
Published in Clinical and Experimental Hypertension, 2023
Deping Wu, Jinli Nie, Huagang Lin, Dexian Zhang, Zhibin Ye, Wan Zhang, Jing Xiao
Renal artery stenosis (RAS) is a cause of chronic kidney disease (CKD), especially severe RAS, which can seriously affect renal blood flow and the glomerular filtration rate (GFR) and lead to renal parenchymal damage (1). Based on the stenotic degree of renal artery luminal diameter, RAS is divided into low-grade (lumen reduced by <60%) and high-grade RAS(lumen reduced by ≥60%) (2). In fact, the current paradigm regarding the treatment of RAS stresses on high-grade stenosis rather than low-grade stenosis. For a long time, whether the low-grade RAS needs timely treatment has not attracted much attention. However, in recent years, studies have reported that regardless of the degree of RAS, even low-grade stenosis, compared with patients without stenosis, it can also cause renal hypertension, kidney damage and increase the risk of cardiovascular events in patients (3–5). Therefore, for patients with CKD, the presence of low-grade RAS may accelerate the progress of CKD and screening for RAS, even low-grade RAS, in CKD patients is the first step to initiating proper treatment. In addition, many studies have reported that CKD and RAS are both associated with high levels of inflammatory markers (6,7). Many inflammatory cytokines and markers have been correlated with chronic kidney conditions such as uric acid, lymphocyte/monocyte ratio (LMR), neuregulin and CRP/albumin ratio (8–11). Therefore, it is logical studying association between CKD and RAS.
Posterior reversible encephalopathy syndrome in carcinoid tumor
Published in Baylor University Medical Center Proceedings, 2022
Thuy-Tien Ho, Venkatesh Aiyagari
In view of her refractory hypertension and metabolic abnormalities, a workup for etiologies of secondary hypertension was pursued. Kidney ultrasound showed no evidence of renal artery stenosis. Endocrine studies showed persistent hypercortisolemia with normal renin and aldosterone. Serum adrenocorticotropic hormone (ACTH) was significantly elevated (337 pg/mL, normal 10–60). A dexamethasone suppression test was deferred since antiepileptic drugs could interfere with dexamethasone metabolism. A pituitary gland MRI was normal; inferior petrosal sinus sampling was not supportive of ACTH secretion from the pituitary gland. Chest and abdominal computed tomography (CT) demonstrated an 11 mm nodule in the lingula (Figure 2), enlarged nodular thickening of both adrenal glands, and osteopenia with mild compression deformities of the lumbar spine. A whole body Octreoscan with 7 mCi of [111In]-pentetreotide and single-photon emission CT demonstrated bilateral adrenal gland hyperplasia with no scintigraphic evidence of octreotide-avid neoplasm. However, the lingular area was impaired by a diaphragmatic motion artifact and the borderline of scintigraphic resolution.
Effect of allisartan on blood pressure and left ventricular hypertrophy through Kv1.5 channels in hypertensive rats
Published in Clinical and Experimental Hypertension, 2022
Chunfang Xu, Ziying Zhao, Wang Yuan, Zhao Fengping, Yan Zhiqiang, Zhang Xiaoqin
Renal artery stenosis, an established method to induce hypertension, was performed according to the method described by Kaur and Muthuraman (20). The narrowing of renal artery due to clipping leads to increased BP (21). Briefly, left kidney of SD rats was exposed by left paracostal celiotomy after anesthetizing the animals with isoflurane inhalation. Blunt tipped vascular scissors and hooks were used to isolate renal artery, vein, and nerve, while left renal artery was clipped using a vascular clip and secured with nylon suture. A change in kidney color from dark brown to yellowish red was observed due to application of clip on the renal artery. Once the artery was clipped, the kidney was placed back in its original position, and then, the cavity was sutured in two layers (muscle and skin). Post-surgery, antibiotic powder was applied topically over the wound. During the surgery, the body temperature was maintained by placing the animal in supine position on a thermo controlled (37°C) heating pad and monitored using a digital rectal thermometer.