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The cardiovascular system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Mary N Sheppard, C. Simon Herrington
In patients with secondary hypertension, renal disease is 10 times more common than all other causes added together. Hypertension is caused by disorders of the renal blood vessels (renovascular hypertension), many renal diseases (renal parenchymal hypertension), or simply loss of nephrons in renal failure.
Altered Regulation of Fibrinolysis in Scleroderma and Potential for Thrombolytic Therapy
Published in Pia Glas-Greenwalt, Fibrinolysis in Disease Molecular and Hemovascular Aspects of Fibrinolysis, 2019
Marvin J. Fritzler, David A. Hart
Systemic sclerosis (scleroderma) is a collagen vascular disease that typically involves multiple organs. With the exception of renovascular hypertension, the treatment of patients with this disease has not substantially influenced survival over the past decade. This lack of progress can be attributed to the heterogeneity of the patient population, a lack of understanding of the etiology and pathophysiology of the disease, and difficulty in diagnosing the disease in its early stages. In the past few years, advances have been made in our understanding of the pathophysiology of scleroderma. This chapter reviews the nature of the disease and then focuses on evidence that implicates fibrinolytic abnormalities during disease progression. These investigations have raised the possibility that thrombolytic therapy is a beneficial modality in the treatment of some patients with the disease.
Hypertension
Published in Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins, The Junior Doctor’s Guide to Cardiology, 2017
Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins
Reduced renal blood flow can cause hypertension by activating the renin-angiotensin-aldosterone system, with subsequent salt and water retention. Increasing age and atherosclerosis are contributing factors. Renovascular hypertension should be suspected in patients with progressive renal failure, refractory hypertension (HTN), severe HTN, worsening of renal function with ACE inhibitors, recurrent pulmonary oedema or asymmetrical kidney size. Fibromuscular dysplasia is the commonest cause in young women.
Resistant hypertension after renal infarction in a man with fibromuscular dysplasia
Published in Blood Pressure, 2021
Nikolina Bukal, Dražen Perkov, Luka Penezić, Bojan Jelaković, Živka Dika
Among patients with renovascular hypertension around 10%. accounts on FMD. According to the ARCADIA POL and FEiRI data renovascular hypertension is common form of FMD (84-90,9%), generally well controlled with low median number of antihypertensive drugs (median (IQR) = 2 (1–3)). Resistant hypertension is observed in 8,1% of FMD patients which represent the patients that should be screened for renovascular hypertension [2,10]. Renal angiography of our patient showed multifocal FMD of a distal portion of the right renal artery with dissection and renal infarction. Radionuclide scan confirmed kidney afunction. Barbey et al. reported a case of a young man initially diagnosed as a ureteral colic with microhaematuria and normal BP who developed severe hypertension with hypokalaemia six weeks later. Further investigations revealed 2 cm smaller affected kidney on abdominal ultrasound, massive renal infarction secondary to renal multifocal FMD dissection on renal angiography and kidney afunction on radionuclide scan. His renovascular hypertension was successfully treated and controlled with 20 mg of lisinopril [11]. Our patient had severe most likely resistant hypertension with target organ damage and eventually his hypertension was successfully treated with simple nephrectomy and later on controlled with 1 mg of trandalopril.
Non-coronary atherosclerotic cardiovascular disease in patients with familial hypercholesterolaemia
Published in Current Medical Research and Opinion, 2020
Panagiotis Anagnostis, Konstantina Vaitsi, Gesthimani Mintziori, Dimitrios G. Goulis, Dimitri P. Mikhailidis
Limited data exist regarding the prevalence of RAD in individuals with FH. In a cross-sectional study from Japan (n = 117 HeFH, 79 men, mean age 53 years, no history of prior MI), renal arteriosclerosis (using aortic angiography) was diagnosed in 33% of the HeFH patients. Of note, 64% of cases had mild stenosis (defined as <25%), more frequently proximal to the bifurcation of the renal artery (74% of cases), without difference between sides. Moreover, only two subjects were diagnosed with either aneurysm or renovascular hypertension (RVHT), manifesting renal artery stenosis of ≥90%. Concerning contributing risk factors, advanced age was the sole parameter modifying the association between RAD and FH (multivariable-adjusted OR 4.88, p < .01). Furthermore, FH women with 3-vessel CHD presented the highest prevalence of RAD, although the sample size was too small to draw definitive conclusions (4 out of 5 vs 9 out of 28 women with 3- and without vessel disease, respectively, p < .05); there was a lack of association between RAD and CHD in the whole group and in men68.
Clinical characteristics of concurrent primary aldosteronism and renal artery stenosis: A retrospective case–control study
Published in Clinical and Experimental Hypertension, 2021
Xu Meng, Yan-Kun Yang, Yue-Hua Li, Peng Fan, Ying Zhang, Kun-Qi Yang, Hai-Ying Wu, Xiong-Jing Jiang, Jun Cai, Xian-Liang Zhou
Five PA with RAS patients with a missed diagnosis of PA during their first hospitalization also underwent PA screening; however, SLT was not performed because of a negative orthostatic ARR result. At the same time, diagnoses of RAS and renovascular hypertension were confirmed in these five patients, and all renal artery stenoses were successfully treated by interventional procedures (four PTRAS and one PTRA procedure). However, these patients were rehospitalized within 1–7 years after the first interventions because of refractory hypertension and hypokalemia of varying severity. Doppler flow imaging of renal angiography showed no restenosis. Notably, PA screening yielded a positive result for all five of these patients, and the diagnosis of PA with RAS was confirmed by SLT.