Hypertension Due to Renal-Artery Stenosis

Annals of Surgery, 1966

2021

Arterial hypertension (AH) in children up to 13 years old is defined as systolic blood pressure, diastolic blood pressure, or both above the 95th percentile for their age, sex, weight, and height by percentile. In children older than 13, it is defined by values greater than or equal to 130 × 80 mmHg. A diagnosis of Takayasu's arteritis is only established as set forth in the EULAR/PRINTO/PRES diagnostic criteria (2008) the mandatory criterion is an angiography of the aorta and its main branches or of the pulmonary arteries showing an aneurysm, dilatation, stenosis, occlusion, or thickening of the vessel wall, while discarding other possibilities. Additionally, at least one of these minor criteria must be present pulse deficit or claudication; blood pressure (BP) discrepancy in any of the four limbs; cardiac or arterial murmurs, systemic arterial hypertension; and acute-phase laboratory reactions (erythrocyte sedimentation rate > 20 mm or C-reactive protein above the reference...

Heart, 1979

The rare opportunity arose to assess in detail the renin-angiotensin system before and after the development of a renal artery stenosis with severe hypertension. Peripheral plasma concentrations of renin, angiotensin II, and aldosterone were known to be normal before the development of renal artery stenosis, and there were no lateralising features on renal vein sampling. Acute hypertension associated with very high peripheral plasma concentrations of renin and angiotensin II, and with pronounced lateralisation on renal vein sampling followed the development of acute unilateral renal artery stenosis. These measurements all returned to normal after nephrectomy, conforming with the pattern of changes previously established only in experimental animals. Unilateral renal artery constriction is a classical means of inducing experimental hypertension (Goldblatt et al., 1934), and renal artery stenosis is a well recognised, potentially correctable cause of clinical hypertension (Foster et al., 1975). After

Medical Journal of Indonesia, 2014

Abstrak Hipertensi sekunder jarang terjadi, namun harus menjadi kecurigaan pada pasien usia muda. Hipertensi sekunder harus didiagnosis dan ditatalaksana secara tepat. Stenosis arteri renalis merupakan salah satu penyebab hipertensi sekunder. Tujuan dari laporan kasus ini adalah menjelaskan diagnosis, patofisiologi dan tata laksana hipertensi sekunder akibat stenosis arteri renalis pada usia muda. Seorang pria berusia 17 tahun dengan gejala sesak nafas didiagnosis menderita hipertensi tahap 3 pada pemeriksaan rutin di Rumah Sakit Pasar Rebo, Jakarta. CT scan abdomen menunjukkan stenosis arteri renalis bilateral. Prosedur invasif PTA (Percutaneous Transluminal Angiography) arteri renalis kiri dilakukan di Pusat Jantung Nasional Harapan Kita dan satu stent dipasang dengan hasil baik. Tekanan darah setelah pemasangan stent normal.

The Lancet, 1986

A retrospective analysis was done on 235 hypertensive patients undergoing renal arteriography. Ofthe 85 patients with renal artery stenosis 50 underwent 56 operations or angioplasties and have been followed up for at least a year. 41 (73%) of these procedures were curative or led to improved blood-pressure control. These results make it worthwhile identifying hypertensive patients with renal artery stenosis who may benefit from surgery or angioplasty. Vascular disease, epigastric bruit, and impaired renal function were commoner in the renal artery stenosis patients than in the 81 with normal arteriograms, but there were no features pathognomonic of stenosis. Intravenous urography had a sensitivity of 83% and a specificity of 69 ·5% in identifying renal artery stenosis; those for isotope renography were 90 ·5% and 38 ·5%, respectively. Divided renal vein renins did not predict the outcome of intervention. Arteriography should, if there are no contraindications to intervention, be the first and definitive investigation when renal artery stenosis is suspected—for instance, in hypertensive patients with accelerated or malignant hypertension, those whose blood pressure is poorly controlled by multiple therapy, and those who have had recent deterioration in blood-pressure control or renal function.

American Journal of Medicine, 1964

The Journal of Clinical Hypertension, 2016

Italian Journal of Medicine, 2019

Renal artery stenosis is a frequent cause of secondary hypertension, but the diagnostic and therapeutic management of these hypertensive patients is controversial. We report a case of secondary hypertension due to renal artery stenosis, treated with the implantation of a drug-eluting stent.

Pediatric Nephrology, 2014

Background Atherosclerosis causing renal artery stenosis (RAS) is one of the most common secondary causes of hypertension in adults, but is rare in children. Case-diagnosis/treatment RAS associated with coronary artery stenosis was diagnosed in a teenage patient who presented with intermittent chest pain and elevated blood pressures for 6 years. The diagnosis of RAS was suspected after physical examination revealed an abdominal bruit. Renal ultrasound with Doppler revealed normal appearing kidneys with high velocity in the aorta and renal arteries. Computed tomography angiography (CTA) of the chest and abdomen demonstrated generalized calcified atherosclerotic narrowing of the arteries including the renal, celiac, superior mesenteric and coronary arteries in the setting of hyperlipidemia. The lipid panel revealed hypercholesterolemia with elevated serum plant sterol concentrations, suggesting the diagnosis of sitosterolemia. Cardiac catheterization demonstrated left anterior descending artery and left circumflex artery stenosis, which required bypass of the left anterior descending artery and stenting of the left circumflex artery. Aggressive lipid control was recommended and he was treated medically with a beta-blocker, low-dose angiotensin-converting enzyme inhibitor, aspirin, statin, and clopidogrel. Conclusion Although very rare, generalized atherosclerosis caused by genetic disorders should be considered an underlying cause for severe hypertension in children with hyperlipidemia.

Hypertension Journal, 2016

Hypertension is one of the most important risk factors for mortality and morbidity globally. It is the most common chronic cardiovascular disease that results in increased hospital admissions worldwide. As hypertension has a long list of primary as well as secondary causes, hypertension induced by renal artery stenosis (RAS) is a form of secondary hypertension caused by renin overproduction and it affects approximately 2 to 5% of hypertensive patients. We report a case of RAS as a cause of resistant hypertension. It is important to make a note that resistant hypertension is the blood pressure above a goal despite adherence to at least three optimally dosed antihypertensive medications of different classes, one of which is a diuretic. Besides, there are other categories of resistant hypertension or difficult-to-treat hypertension such as primary hyperaldosteronism, thyrotoxicosis, chronic kidney disease, drug-drug interactions as well steroids, nonsteroidal anti-inflammatory drugs, erythropoietin, and herbal preparations such as liquorice. Morbid obesity is also associated with resistant hypertension.