|
Link to this page
Your search term(s) "renal artery stenosis " returned 22 results.
Displaying all search results.
Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: 2007 Update. Rockville, MD: Agency for Healthcare Research and Quality. 2007. 33 p.
This report is an update to a Comparative Effectiveness Review about management strategies for renal artery stenosis (RAS). The original review in October 2006 included all studies of patients with atherosclerotic RAS (ARAS) that compared two or more interventions. In addition, it reviewed recent prospective cohort––single arm––studies of angioplasty with stent placement, prospective cohort studies of medical interventions, cohort studies of RAS natural history, and prospective or large retrospective studies of surgical bypass. This update evaluated the same questions and used the same eligibility criteria, updating the literature search through April 2007. This report does not address the management of fibromuscular dysplasia, renal transplant recipients, or patients who have a previous failed revascularization. The report includes an executive summary, introduction, discussion of methods, report of results, discussion of findings, a list of references, a list of abbreviations, a table that summarizes the reviewed studies, and appendices of the search strategy, excluded studies, peer reviewers, and supplemental tables and figures. The authors contend that none of the studies evaluated the principal question of interest, that is, the relative effects of intensive medical therapy and angioplasty with stent for patients with ARAS. They conclude that the evidence does not support one treatment approach over the other for the general population of people with ARAS. 5 figures. 1 table. 93 references.
Full Record Printer Friendly Version
Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: 2007 Update. Executive Summary. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ). 2007. 4 p.
This report is a 2007 update to a 2006 Comparative Effectiveness Review on management strategies for renal artery stenosis (RAS). The original systematic review included all studies of patients with atherosclerotic RAS (ARAS) that compared two or more interventions, and single arm studies of angioplasty with stent placement, prospective cohort studies of medical interventions, cohort studies of RAS natural history, and prospective or large retrospective studies of surgical bypass. The 2007 update evaluated the same questions and used the same eligibility criteria. The questions focused on the evidence for or against aggressive medical therapy compared with renal artery angioplasty with stent placement on long-term clinical outcomes; what clinical, imaging, laboratory, and anatomic characteristics are associated with improved or worse outcomes; and what treatment variables are associated with improved or worse outcomes, including periprocedural medications, type of stent, use of distal protection devices, or other adjunct techniques. The update added eight new studies to the 60 studies included in the original report. The authors conclude that the evidence does not support one treatment approach over the other for the general population of people with ARAS. Readers are referred to the full report online at www.effectivehealthcare.ahrq.gov/reports/final.cfm.
Full Record Printer Friendly Version
Management of Atherosclerotic Renal Artery Stenosis: Clinician’s Guide. Rockville, MD: Agency for Healthcare Research and Quality. 2007. 2 p.
This fact sheet summarizes clinical evidence about the effectiveness and safety of angioplasty and medical therapy for treating atherosclerotic renal artery stenosis (ARAS). The fact sheet does not address how to choose a diagnostic strategy for assessing suspected ARAS and does not discuss renal artery stenosis due to fibromuscular dysplasia. The fact sheet stresses that, overall, insufficient evidence exists to determine whether angioplasty with stenting is a better treatment for ARAS than aggressive medical therapy alone. Both medical therapy and angioplasty lower blood pressure. Attainment of blood pressure control is more likely after angioplasty than with medical therapy alone. However, the benefits of angioplasty may be limited to people with bilateral disease. A small percentage––4 to 18 percent––of people who have had angioplasty plus stent can discontinue blood pressure medications. The risks of drug therapy for ARAS include side effects of antihypertensive drugs, such as dizziness, sexual problems, headache, and cough. The risks of angioplasty include death after surgery in about 1 percent of patients and restenosis without 40 months in about 10 to 21 percent of patients. Readers are referred to a website for additional information: www.effectivehealthcare.ahrq.gov. 1 figure.
Full Record Printer Friendly Version
Renovascular Hypertension. IN: Nilsson, K.R.; Piccini, J.P., eds. Osler Medical Handbook. Philadelphia, PA: Saunders. 2006. pp. 741-747.
Renovascular hypertension is a secondary cause of hypertension that results from poor renal perfusion secondary to flow-limiting lesions. This chapter on renovascular hypertension is from a handbook that provides the essentials of diagnosis and treatment, as well as the latest in evidence-based medicine, for residents working bedside, in-patient care. The chapter begins with a presentation of essential Fast Facts and concludes with Pearls and Pitfalls useful to the practicing internist. The body of the chapter is divided into sections: Epidemiology, Clinical Presentation, Diagnosis, and Management. Specific topics covered in this chapter include the two most common causes of renovascular hypertension: atherosclerosis (which causes about 90 percent) and fibromuscular dysplasia (FMD); stenosis (narrowing) greater than 75 percent in one or both renal arteries used as the diagnosis of renal artery stenosis; and the retrospective diagnosis of renovascular hypertension when blood pressure control improves after revascularization of a stenotic lesion. The chapter concludes with a list of references, each labeled with a 'strength of evidence' grade to help readers determine the type of research available in that reference source. 2 figures. 17 references.
Full Record Printer Friendly Version
Diagnostic Imaging in Kidney Transplantation. IN: Danovitch, G.M. Handbook of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 347-368.
The clinician evaluating a patient with renal transplant dysfunction has the choice of a variety of imaging procedures, including ultrasound (US), nuclear medicine (NM) or molecular imaging, computed tomography (CT), magnetic resonance imaging (MRI), and excretory urography. This chapter on diagnostic imaging in kidney transplantation is from a handbook that offers a practical guide for health care providers who manage kidney transplant patients. In this chapter, the authors focus on the use of US and NM techniques in kidney transplantation. They also note that CT, MRI, and urography may, on occasion, be the optimal imaging modalities for certain clinical problems encountered in renal transplant recipients. Specific topics include the radiologic evaluation of the living donor; radiologic techniques in the early posttransplant period (up to 3 months), including that for hematomas, urinomas, lymphoceles, abscesses, and acute rejection; nuclear medicine imaging of graft function and dysfunction; posttransplantation vascular complications, including arterial thrombosis, infarction, renal vein thrombosis, chronic rejection, renal artery stenosis, arteriovenous fistulas, and pseudoaneurysms; and measurement of glomerular filtration rate. 13 figures. 1 table. 13 references.
Full Record Printer Friendly Version
Evaluation and Treatment of Graft Dysfunction. In: Medical Management of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 153-187.
Accurate and timely diagnosis of the cause and then effective treatment of allograft dysfunction in order to minimize any irreversible injury is a critical factor in maximizing long-term allograft success rates. This chapter on the evaluation and treatment of graft dysfunction is from a textbook that provides a compendium of the latest advances and understandings regarding the complex medical problems seen in kidney transplant patients. The first section of the chapter considers the measurement of allograft function, including the roles of serum creatinine, 24 hour creatinine clearance, formulas that estimate glomerular filtration rate (GFR), serum cystatin C, radionuclide and radiocontrast determinations of GFR, ultrasonography, radionuclide imaging, and noninvasive diagnosis of acute rejection. The authors also consider dysfunction immediately after transplantation, including evaluation, hyperacute rejection, vascular occlusion, delayed graft function, urologic complications, and hypovolemia; deterioration of allograft function early after transplantation, including diagnosis, acute cellular rejection, acute antibody-mediated rejection, urologic complications, acute calcineurin inhibitor nephrotoxicity, and de novo thrombotic microangiopathy; and deterioration of allograft function more than 6 months after transplantation, including chronic allograft nephropathy, chronic calcineurin inhibitor nephrotoxicity, chronic allograft rejection, late acute rejection, chronic humoral rejection, transplant renal artery stenosis, and recurrent and de novo glomerular disease. 9 tables. 439 references.
Full Record Printer Friendly Version
Transplant Operation and Its Surgical Complications. IN: Danovitch, G.M. Handbook of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 193-211.
Kidney transplantation is an elective or semi-elective surgical procedure performed in patients who have undergone careful preoperative assessment and preparation. Chronic dialysis enables patients to be maintained in optimal condition and provides time to address potentially complicating medical and surgical issues. The authors of this chapter discuss these preparations. The chapter, on the transplant operation and its surgical complications, is from a handbook that offers a practical guide for health care providers who manage kidney transplant patients. Specific topics include immediate preoperative preparations, operative techniques, surgical considerations in young children, intraoperative fluid management, dual-kidney transplantation, and the surgical complications of kidney transplantation, including wound infection, lymphocele, bleeding, graft thrombosis, the need for perioperative anticoagulation, renal artery stenosis, urine leaks, and ureteral obstruction. An additional section discusses allograft nephrectomy (removal of prior kidney transplants that have failed). 6 figures. 2 tables. 14 references.
Full Record Printer Friendly Version
Pitfalls in Imaging for Renal Stenosis. Annals of Internal Medicine. 141(9): 730-731. November 2004.
Renal artery stenosis (constriction) can progress to threaten kidney function and complicate congestive heart failure; it is an important cause of secondary hypertension. This editorial addresses some of the pitfalls in imaging studies used to measure renal artery stenosis. The editorial accompanies an article in this same issue on noninvasive tests for diagnosing renal artery stenosis (Vasbinder et al) that demonstrated problems with limited performance of vascular imaging methods. The editorial stresses that before starting out on the path to rule out renal artery stenosis, the internist must decide whether the risks for treatment-resistant hypertension, underlying ischemic nephropathy (kidney disease caused by lack of blood flow), or both outweigh the risks associated with invasive tests and treatment. However, benefits from renal revascularization surgery can be substantial, so the need to evaluate the vascular supply to the kidneys must be balanced against the risks for invasive studies for each patient.
Full Record Printer Friendly Version
Smoking and the Kidney. JASN. Journal of the American Society of Nephrology. 13(6): 1663-1672. June 2002.
This article reviews the impact of smoking as a major risk factor for kidney disease. The author describes the adverse renal (kidney) effects of smoking in the general population, including in the elderly; the adverse renal effects of smoking in patients with primary hypertension (high blood pressure); the adverse renal effects of smoking in patients with renal diseases, including diabetic nephropathy (kidney disease associated with diabetes mellitus), primary renal disease, and systemic diseases involving the kidney; smoking and atherosclerotic renal artery stenosis (narrowing) or ischemic nephropathy (kidney disease due to lack of appropriate blood flow in the organ); the adverse effects of smoking in patients with a renal transplant; the pathohistologic features of smoking-induced renal damage; the potential mechanisms of smoking-induced renal damage; and the reversibility of smoking-induced renal damage. The author concludes that smoking has a negative impact on kidney function even in subjects without apparent renal disease, but the adverse renal effects of smoking are particularly marked in patients with different types of kidney disease. Thus, major efforts are justified to help patients quit smoking. 1 figure. 4 tables. 87 references.
Full Record Printer Friendly Version
Atherosclerotic Renal Artery Stenosis: To Treat Conservatively, to Dilate, to Stent, or to Operate?. JASN. Journal of the American Society of Nephrology. 12(10): 2190-2196. October 2001.
Atherosclerotic renal artery stenosis (ARAS, a condition in which the arteries serving the kidney are narrowed by deposits of plaque) may cause hypertension (high blood pressure), progressive renal failure, and recurrent pulmonary edema (fluid accumulation in the lungs). Revascularization (bringing new arteries) by surgery, with or without stenting, is effective in restoring renal artery patency; it can also lower blood pressure and prevent clinical events such as progressive kidney failure and recurrent heart failure. However, the use of revascularization to treat ARAS has serious limitations, and trial studies assessing the value of revascularization are in the design and early stages. This article reviews the recent evidence concerning the course and documented benefits of revascularization in patients with ARAS; the authors also propose strategies for the management of such patients. Data show that most patients undergoing angioplasty (reconstruction of blood vessels) or surgery still need antihypertensive agents 6 or 12 months after the procedure. The reduction in treatment required by patients undergoing revascularization should therefore be weighed against the risks of complications and restenosis, particularly in cases with extended atherosclerosis and moderate to severe kidney failure. Most elderly patients with ARAS are likely to die from coronary heart disease or stroke before end stage renal disease (ESRD) occurs. In all age groups, such extra renal events can effectively be prevented by antihypertensive agents, statins, and aspirin. 1 figure. 4 tables. 31 references.
Full Record Printer Friendly Version
Renal Artery Stenosis: A Common, Treatable Cause of Renal Failure?. In: Coggins, C.H.; Hancock, E.W., Eds. Annual Review of Medicine: Selected Topics in the Clinical Sciences, Volume 52. Palo Alto, CA: Annual Reviews Inc. 2001. p. 421-442.
Chronic azotemic (with excessive amounts of nitrogen in the blood) renovascular disease is common in patients with atherosclerosis, and its prevalence appears to be increasing in the aging population. How often it is the primary cause of end stage renal disease (ESRD) is not yet certain. Some studies suggest that 10 to 40 percent of elderly patients with hypertension (high blood pressure) with newly documented ESRD and no demonstrable primary kidney disease have singificant renal artery stenosis (narrowing). This article considers renal artery stenosis (RAS) and its role in renal (kidney) failure. The authors note that methods of identifying patients whose kidney function is at true risk from vascular occlusive disease and then determining who will benefit from treatment remain elusive. The presence of RAS in an azotemic patient can be assessed with noninvasive and risk free radiologic techniques. Functional tests that predict the change in kidney function after revascularization are not yet available. However, a renal length of greater than 7.5 centimeters in the absence of renal cysts and a short history of renal functional deterioration indicate a good prognosis. The authors review the indications for revascularization surgery: patients with recent deterioration in kidney function, those with bilateral (both sides) RAS, those with flash pulmonary edema (fluid accumulation in the lungs), those with advanced chronic kidney failure or ESRD, those with reversible azotemia during ACE inhibitor (an antihypertensive drug) therapy, and those whose conditions cannot be managed medically. In azotemic groups, 25 to 30 percent of patients achieve important recovery of kidney function with revascularization surgery. The decision to recommend revascularization remains a difficult balance between the risks and expense of the procedure and the undoubted benefits that accrue if renal function is successfully stabilized. 4 figures. 1 table. 127 references.
Full Record Printer Friendly Version
Use of Doppler Ultrasonography to Predict the Outcome of Therapy for Renal-Artery Stenosis. New England Journal of Medicine. 344(6): 410-417. February 8, 2001.
Prospectively identifying patients whose renal function or blood pressure will improve after the correction of renal artery stenosis (narrowing of the blood vessels feeding the kidneys) has not been possible. This article reports on a study that evaluated whether a high level of resistance to flow in the segmental arteries of both kidneys can be used to prospectively select appropriate patients for treatment. The authors evaluated 5,950 patients with hypertension for renal artery stenosis using color Doppler ultrasonography. Among 138 patients who had unilateral or bilateral renal artery stenosis of more than 50 percent of the luminal diameter and who underwent renal angioplasty or surgery, the procedure was technically successful in 131 patients (95 percent). Creatinine clearance (a measure of kidney function) and 24 hour ambulatory blood pressure were measured before surgical correction of the renal artery stenosis and at regular interludes after the procedure (3, 6, and 12 months, then yearly thereafter). Among the 35 patients (27 percent) who had resistance index values of at least 80 before revascularization, the mean arterial pressure did not decrease by 10 mm Hg or more after revascularization in 34 (97 percent). Renal function declined in 28 patients (80 percent); 16 patients (46 percent) became dependent on dialysis; and 10 (29 percent) died during followup. Among the 96 patients (74 percent) with a resistance index value of less than 80, the mean arterial pressure decreased by at least 10 percent in all but 6 patients after revascularization; renal function worsened in only 3, all of whom became dependent on dialysis; and 3 died. The authors conclude that a renal resistance index value of at least 80 reliably identifies patients with renal artery stenosis in whom angioplasty or surgery will not improve renal function, blood pressure, or kidney survival. 3 figures. 3 tables. 32 references.
Full Record Printer Friendly Version
What's New in Urology?. Journal of the American College of Surgeons. 193(2): 179-201. August 2001.
In this lengthy review article, the author summarizes advances in different subspecialties of urology, including andrology and infertility, benign prostatic hypertrophy (BPH), erectile dysfunction (ED, formerly called impotence), urinary incontinence and voiding dysfunction, infections and inflammatory conditions, pediatrics, renal (kidney) stone disease, trauma, and urologic oncology (cancer), including that in the prostate, kidney, transitional cell tumors, tumors in the testes. In each area, the author reviews surgical treatment, medical therapy, other treatments, complications, and patient care management considerations. The section on pediatrics covers infections, bladder anomalies, reflux (return of urine from the bladder back to the kidneys), testicular conditions, tumors, hypospadias (a developmental anomaly in the male in which the urethra opens on the underside of the penis or on the perineum) repair, and reconstruction. An additional section notes the miscellaneous studies from the year, including in the areas of laparoscopy, renal artery stenosis (narrowing of the arteries serving the kidneys), contrast induced nephrotoxicity, thromboembolism, adrenal lesions and imaging, female sexual dysfunction, renal transplantation, and a study of how patients use the Internet. 228 references.
Full Record Printer Friendly Version
Doppler and Ultrasound Methods for Diagnosis. Seminars in Nephrology. 20(5): 445-449. September 2000.
With the availability of ultrasonic duplex scanning there is now a method of safely screening those patients who may be thought to have renal artery stenosis as the basis for hypertension or renal failure. This article describes Doppler and ultrasound methods for diagnosis. Modern instrumentation combined with an experienced technologist makes this a reasonable and accurate screening test. One of its major advantages is that it can be used for repeat studies to document the outcome of any form of intervention designed to remove or bypass areas of stenosis. Another great advantage is the role of ultrasound in documenting both the degree of narrowing and its effect on kidney size. It is now known, because of information obtained with this technology, that high grade renal artery stenoses are accompanied by a decrease in kidney size. It is also possible to document disease progression with atherosclerotic involvement of the renal arteries. The author concludes that with more widespread use of this method, useful information can be obtained on how renal artery disease should be treated and monitored. 2 tables. 22 references.
Full Record Printer Friendly Version
Effect of Balloon Angioplasty on Hypertension in Atherosclerotic Renal-Artery Stenosis. New England Journal of Medicine. 342(14): 1007-1014. April 6, 2000.
Patients with hypertension (high blood pressure) and renal artery stenosis (narrowing of the blood vessels to the kidney) are often treated with percutaneous transluminal renal angioplasty. However, the long term effects of this procedure on blood pressure are not well understood. This article reports on a study investigating the effect of balloon angioplasty on hypertension in these patients. The authors randomly assigned 106 patients with hypertension who had atherosclerotic renal artery stenosis and a serum creatinine concentration (a measure of kidney function) of 2.3 mg per deciliter or less, to undergo percutaneous transluminal renal angioplasty or to receive drug therapy. To be included, patients also had to have a diastolic blood pressure of 95 mm Hg or higher, despite treatment with two antihypertensive drugs. Blood pressure, doses of antihypertensive drugs, and renal function were assessed at 3 and 12 months, and patency of the renal artery was assessed at 12 months. At three months, the blood pressures were similar in the two groups; at that time, patients in the angioplasty group were taking 2.1 (plus or minus 1.3) defined daily doses of medication and those in the drug therapy groups were taking 3.2 (plus or minus 1.5) daily doses. In the drug therapy group, 22 patients underwent balloon angioplasty after three months because of persistent hypertension despite treatment with three or more drugs or because of a deterioration in renal function. According to intention-to-treat analysis, at 12 months, there were no significant differences between the angioplasty and drug therapy groups in systolic and diastolic blood pressures, daily drug doses, or renal function. The authors conclude that, in the treatment of patients with hypertension and renal artery stenosis, angioplasty has little advantage over antihypertensive drug therapy. 1 figure. 3 tables. 24 references.
Full Record Printer Friendly Version
Epidemiology and Clinical Presentation. Seminars in Nephrology. 20(5): 426-431. September 2000.
Renovascular (kidney blood supply) disease appears to be increasing in prevalence, particularly in older patients with atherosclerotic disease elsewhere in their bodies. This article discusses the epidemiology and clinical presentation of renovascular disease, which are changing because of rapid advances in medical therapy and other comorbid events. Although fibromuscular dysplasia and other diseases affecting the renal artery can produce the syndrome of renovascular hypertension (high blood pressure), atherosclerotic renal artery stenosis (narrowing) is the most common clinical entity. RAS can produce a spectrum of manifestations, ranging from asymptomatic (incidental), identified during angiographic evaluation of other conditions, to progressive hypertension to accelerated cardiovascular disease with pulmonary edema (fluid on the lungs) and advanced renal failure. With the widespread application of drugs which block the renin angiotensive system, including ACE inhibitors and angiotensin antagonists, many cases of renovascular hypertension remain unsuspected and never produce adverse effects. The author cautions clinicians to remain alert to the potential for disease progression, with the potential for total renal artery occlusion (blockage) or loss of viable kidney tissue. Selection of patients for renal revascularization surgery depends on individual balance of risks and benefits regarding the likely outcomes regarding both improvements in blood pressure control and preservation of renal function. 1 figure. 2 tables. 38 references.
Full Record Printer Friendly Version
Focus On: Renal Disease in Alagille Syndrome. LiverLink. 7(4): 1, 3-8. October-December 2000.
Kidney (renal) disease is now recognized as a common feature of Alagille syndrome (AGS) and may be present in up to 40 percent of AGS patients. A variety of renal abnormalities that have a very wide spectrum of clinical significance (symptoms and complications) and severity have been described in AGS. This newsletter article reviews renal disease associated with AGS. AGS renal disease is a mixture of defects in the formation of the kidney, problems from lipid (fat) deposition in the kidney secondary to cholestasis (retention of bile contents in the blood stream), and vascular abnormalities. Each of these problems can lead to alteration in the normal filtration of the kidney. The article reviews the normal function of the kidney, which is to produce urine and keep the body's composition of electrolytes (sodium, potassium, bicarbonate) stable, and to filter proteins and waste products. The author describes defects in the formation of the kidney in AGS, including renal agenesis (absent kidney), duplications of the urinary tract, renal dysplasia (malformation), renal hypoplasia (small kidney with decreased ability to filter), and medullary cystic disease. Renal artery stenosis is a narrowing of the artery supplying the kidney that compromises the blood flow to the kidney. As a result of this stenosis, the kidney eventually shrinks and may lose some function. Many of these conditions lead to a functional renal condition called renal tubular acidosis (RTA); the author reviews this problem and stresses the importance of regular screening for and diagnosis of kidney problems in patients with AGS. 1 table.
Full Record Printer Friendly Version
How to Best Control Hypertension in Patients with Renal Insufficiency. Journal of Critical Illness. 15(9): 468. September 2000.
In general, the same drugs used in patients with essential hypertension (high blood pressure) who have normal kidney function can be used in patients with hypertension and chronic renal insufficiency (CRI), including particular drugs when there are other comorbid conditions. This brief article reviews the clinical strategies for controlling hypertension in patients with renal insufficiency. The author notes two specific recommendations from the Joint National Committee (JNC VI): blood pressure should be lowered to 130 over 85 mm Hg; and patients with hypertension who have CRI should receive, unless contraindicated, an ACE inhibitor to control hypertension and to slow the progression of renal failure. The author cautions against the use of alpha adrenergic blockers, which have been associated with significant orthostatic hypotension (low blood pressure), particularly in patients with autonomic neuropathy (nerve damage) associated with CRI. ACE inhibitors should be used cautiously in patients with proven or suspected renal artery disease, since these agents may precipitate an acute loss of kidney function; if this occurs in a patient in whom renal artery stenosis has not been suspected previously, the diagnosis should be considered. Diuretics are the second choice drugs (after ACE inhibitors). A calcium channel blocker (diltiazem or verapimil) can be added if needed to achieve goal blood pressure. 1 figure. 2 references.
Full Record Printer Friendly Version
Magnetic Resonance Angiography of the Kidney. Seminars in Nephrology. 20(5): 450-455. September 2000.
This article describes magnetic resonance angiography (MRA) of the kidneys, the clinical standard for detecting renal artery stenosis (RAS). This test is performed by injecting a special liquid into the patient's vein scanning with a magnetic resonance imaging (MRI) machine. In addition to displaying the renal arterial anatomy, atherosclerosis within the aorta and iliac arteries is commonly depicted. MRA is a time efficient and safe test when compared with conventional arteriography. Gadolinium enhanced MRA has proven to have a high sensitivity for detecting stenoses in main and accessory renal arteries. Although false negative studies are rare, overestimation of the degree of renal stenosis (narrowing of the vessels of the kidney) is problematic and may lead to false positive diagnosis. To some extent, this tendency to overestimate stenoses can be compensated for by performing phase contrast MRA, a type of MRA based on accumulated phase differences. As with conventional angiography, MRA is still only an anatomic test which provides little information about the functional significance of a stenosis. However, MRA is highly accurate in determining the number of renal arteries, the size of the kidneys, and the presence of any anatomic variants. Ultimately, MRA needs to be combined with a functional test similar in concept to captopril renography. This test, termed MR renography together with MRA may replace the current multimodality approach to the workup of renovascular hypertension. 2 figures. 29 references.
Full Record Printer Friendly Version
Middle-Aged Man with Newly-Discovered Hypertension (commentary). Consultant. 40(1): 59-60. January 2000.
This article is from a column that presents a specific clinical case and then asks readers to describe the appropriate care. The patient in this article is a 52 year old man who comes to the physician for evaluation of hypertension (high blood pressure). On three separate occasions during and since his examination at work, his blood pressure readings have ranged from 190 to 210 over 105 to 112 mm Hg. The patient is otherwise in good health and had no history of hypertension. He smokes between 1 and 2 packs of cigarettes per day. The patient has no history of major medical illness, and a review of systems is negative for cardiac symptoms. The author poses to readers a question regarding additional testing, after initiation of an appropriate hypertension regimen. The 'answer' provided by the author is that this patient's history and physical examination suggest that his hypertension is caused by atherosclerotic renal artery stenosis (RAS). Clinical markers that suggest RAS include severe hypertension in a young patient, the abrupt onset of hypertension after age 50, clinical evidence of peripheral vascular disease, and abdominal or flank bruits on examination. The author stresses that early diagnosis and treatment of RAS may improve or even cure hypertension and can also preserve renal function. Captopril renal scintigraphy is the preferred initial screening study for evaluation of patients with suspected RAS. Renal arteriography is the gold standard for diagnostic confirmation and therapeutic management of RAS, but it is not an ideal screening test because it is invasive and can endanger renal function. 1 table. 3 references.
Full Record Printer Friendly Version
Renal Angioplasty for Lowering Blood Pressure (editorial). New England Journal of Medicine. 342(14): 1042-1043. April 6, 2000.
This editorial comments on a study published in this same issue of the New England Journal of Medicine and offers a historical perspective on the use of renal angioplasty (the reconstruction of damaged blood vessels) for lowering blood pressure. The research study concluded that renal angioplasty is no more effective for control of blood pressure than antihypertensive drug therapy alone. The editorial authors comment that if this study had been performed two decades ago, when today's potent antihypertensive drugs were not available, the outcome might well have been different. The editorial reviews the strengths and weaknesses of the research. The authors conclude that the screening of all hypertensive patients for atherosclerotic renal artery stenosis (narrowing of the artery that supplies the kidney) in order to treat stenosis with renal angioplasty is no longer justified. However, renal angioplasty may still be advisable in some patients whose blood pressure is not controlled with drug therapy, or in those patients with renal artery stenosis in a single kidney. A separate issue is those patients in whom the need for preservation of renal function may be an indication for renal angioplasty.
Full Record Printer Friendly Version
Renovascular Hypertension. AJN. American Journal of Nursing. 100(2): 46-52. February 2000.
This article familiarizes nurses with renovascular hypertension, the most common secondary form of hypertension (the elevation of blood pressure). Renovascular hypertension is treatable and results from renal arterial obstruction, which has several causes: atherosclerosis, fibromuscular dysplasia, or Takayasu's syndrome. The author discusses mechanisms of the disease, the frontline diagnostic tests used (glomerular filtration rate, BUN, urinalysis), additional diagnostic testing that may be utilized, and how nurses can help with patient preparation for these tests. One sidebar discusses the treatment options, noting that ACE inhibitors, calcium antagonists, beta blockers, and certain alpha blockers may lower blood pressure in patients with renal artery stenosis. Each drug has a unique efficacy and adverse effects profile. The author cautions that renovascular hypertension, if unchecked, will progress to complete renal failure; pharmacologic interventions do not correct the underlying cause. Another sidebar reports on a clinical trial of ramipril, an ACE inhibitor currently under study. In high risk patients, ramipril was shown to prevent cardiovascular death, stroke, myocardial infarction, heart failure, diabetic microvascular complications, the development of diabetes, and the need for cardiac revascularization. Appended to the article is a posttest with which readers can earn continuing education credit. 1 figure.
Full Record Printer Friendly Version
Displaying all search results.
Start a new search.
|
