Diabetic Nephropathy
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
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.
Investigation and initial assessment
Julian Tudor Hart in Hypertension, 2018
Renal artery stenosis is a rare cause of hypertension. It is reversible by surgery in about 50% of cases; the rest still have to be controlled medically. Renal artery stenosis rarely causes symptoms unless it presents with the malignant phase, a renal infarct, or hyponatraemic hyptertensive syndrome, with thirst, polyuria, no glycosuria, and salt craving. About half of all cases have an abdominal systolic murmur over the renal arteries, but most such sounds are caused by atheroma rather than primary stenosis, and are a result rather than a cause of hypertension. So even this classic sign is fairly useless, and there is really no satisfactory screening test for this disorder6. The Glasgow MRC Hypertension Research Unit suggests two groups commonly seen by the GP in whom investigation could be reasonably cost-effective. The first group comprises patients under 45 years with moderate or severe high blood pressure. To this I would add ‘and a negative family history of hypertension and with no alcohol problems’. This narrows the field very considerably, as high blood pressure in young men is fairly common, but nearly all cases have one or usually both parents hypertensive, or are heavy drinkers. The second group is of compliant patients with treated high blood pressure whose control deteriorates rapidly and unexpectedly. This may signal thrombotic or embolic occlusion of a renal artery.
Complications of endovascular therapy for occlusive disease of splanchnic arteries including renal arteries
Sachinder Singh Hans, Mark F. Conrad in Vascular and Endovascular Complications, 2021
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.
Blau syndrome with a rare mutation in exon 9 of NOD2 gene
Published in Autoimmunity, 2019
Jelena Velickovic, Fatma Silan, Firdevs Dincsoy Bir, Coskun Silan, Burcu Albuz, Ozturk Ozdemir
We reported a 41-year old female Turkish patient diagnosed as Blau syndrome at COMU Genetic Diagnostic Center. Granulomatous dermatitis and severe headache have been present since she was 8 years old. She has recurrent chest (usually unilateral but sometimes bilateral) and pelvic pain but she has not abdominal pain and not operated for appendicitis. Sacroileitis and arthritis (especially elbow) started when she was 16, hypertension diagnosed when she was 20 and she has early onset severe preeclampsia. She has ischemic stroke and left hemihypoplasia, first was when she was 38 years old and recurrence after 6 months. She has not diagnosed uveitis but she has transient vision loss, first time when she was 38 years old, occurs 3 times (she can’t see 3–5 s, recurrent every 5 min longer than 1 month). Renal artery stenosis diagnosed at 41 years old. She has a plenty of oral afts and a few dermatological lesions now. Her granulomatous dermatological lesions were diagnosed as “Sun allergy” but sun protection (protective creams, long dresses with long arms and even she stays at home during the summer) was not any effect on lesions. She doesn’t have facial dysmorphism or any other difference of body structure. In the family history; her 54 years-old sister has dermatological lesions, pruritus, ankle swelling, arthralgia at hip and hand joints, transient vision loss. Her 50 years-old brother has no active symptoms except pruritus. Her mother died in the forties because of myocardial infarction after seven attacks in three months.
The role of dietary salt and alcohol use reduction in the management of hypertension
Published in Expert Review of Cardiovascular Therapy, 2021
Hypertension is a known clinical problem and which defined as chronically increased systemic arterial BP [1]. It is defined as a systolic BP (SBP) ≥140 mmHg and a diastolic BP (DBP) ≥90 mmHg by a seventh Joint National Committee (JNC 7) [2]. Whereas elevated BP is an SBP ≥140 mmHg and/or a DBP ≥90 mmHg [3]. Hypertension can be classified as essential hypertension and secondary hypertension. About 90–95% of the cases are essential hypertension where the cause is unknown [4]. Whereas secondary hypertension refers to arterial hypertension due to an identifiable cause [5] and affects 5–10% of the general hypertensive population [5–10]. It also refers to hypertension caused by other systemic illnesses as part of their manifestation [4]. The common causes include renal artery stenosis, renal parenchymal disease, phaeochromocytoma, primary aldosteronism, and Cushing’s syndrome [11].
Prevalence of smoking and clinical characteristics in fibromuscular dysplasia. The ARCADIA-POL study
Published in Blood Pressure, 2019
Piotr Dobrowolski, Magdalena Januszewicz, Helena Witowicz, Ewa Warchoł-Celińska, Anna Klisiewicz, Urszula Skrzypczyńska-Banasik, Marek Kabat, Katarzyna Kowalczyk, Anna Aniszczuk-Hybiak, Elżbieta Florczak, Adam Witkowski, Andrzej Tykarski, Krystyna Widecka, Małgorzata Szczerbo-Trojanowska, Witold Śmigielski, Wojciech Drygas, Ilona Michałowska, Piotr Hoffman, Aleksander Prejbisz, Andrzej Januszewicz
FMD was diagnosed as non-atherosclerotic arterial encroachment or stenosis affecting the trunk or branches of medium-sized arteries, in the absence of aortic wall thickening and biochemical evidence of inflammation. The evaluated arteries were divided into vascular beds as follows: (1) renal – including main and accessory arteries (ostium, trunk and branches), (2) cerebrovascular – including extracranial carotid and vertebral arteries and intracranial arteries (the latter were defined as all arteries above scull base), (3) mesenteric – including coeliac trunk, hepatic, superior and inferior mesenteric, left gastric, hepatic and splenic arteries, (4) upper extremity – including brachial and axillary arteries, (5) lower extremity – including common, external and internal iliac arteries and femoral arteries. Multi-site FMD was defined as the presence of FMD changes in two or more of above defined vascular beds. Significant renal artery stenosis was defined as signs of significant stenosis on duplex Doppler examination (renal aortic ratio of 3.0 or more) confirmed either on computer tomography arteriography stenosis of more than 70% of the artery’s diameter was considered as significant) or digital subtraction angiography. Multifocal FMD was diagnosed when characteristic sequential areas of dilation greater in dimension than the adjacent normal vessel and separated by areas of narrowing were identified. Focal FMD was defined as focal concentric stenosis [13]. The diagnosis of FMD and its types was established based on CTA examination by two independent investigators (MJ and IM).
Related Knowledge Centers
- Chronic Kidney Disease
- Coronary Artery Disease
- Fibromuscular Dysplasia
- Renal Artery
- Renovascular Hypertension
- Stenosis
- Hypertension
- Hemodynamics
- Atherosclerosis
- Kidney