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Stenosis of the renal artery: possible causes, symptoms and features of treatment

Elevated blood pressure is a very common problem. Especially among the elderly and middle-aged people. The causes of hypertension can be many. Among them - heart disease, kidney disease, endocrine disorders. As you know, increased pressure can lead to a stroke and a heart attack. To understand how to deal with this symptom, you need to establish the cause. In some cases, hypertension occurs against the backdrop of a pathology such as renal artery stenosis. To start treatment of this disease should be as soon as possible. After all, arterial stenosis can lead not only to an increase in blood pressure, but also to other serious consequences. Pathology is found in both men and women. In some cases, the disease is congenital. More often it occurs against the background of vascular disorders.

More information about renal artery stenosis

Stenosis of the renal artery is the narrowing of the lumen of the vessel, due to various pathological conditions. The disease is attributed to nephropathic pathologies. The renal arteries are large vessels that supply blood to the organ tissue. With stenosis, they noticeably decrease in diameter. As a result, the blood supply to the kidneys is disturbed. This pathology leads to such serious disorders as secondary arterial hypertension, CRF. There are 2 mechanisms for the development of stenosis. Among them:

  1. Atherosclerotic variant. It is observed in the majority of patients suffering from this pathology. A similar mechanism of the development of stenosis is the gradual blockage of the lumen of the vessel with cholesterol plaques. Often the expressed occlusion of the vessel is noted in old age.
  2. Fibromuscular dysplasia. This variant of pathology development is less common. It can take place in middle-aged women, as well as among young girls. Dysplasia of the muscle tissue refers to hereditary congenital defects.

Only after an instrumental examination can you establish a diagnosis of "renal artery stenosis". ICD is a classification of pathologies used throughout the world. It includes a lot of diseases, each of which has a certain cipher. Stenosis of the arteries of the kidneys is coded in 2 ways, depending on the cause of its occurrence. One of the options is the code I15.0, which means "Renovascular hypertension". Another code on the ICD is Q27.1. It stands for "congenital stenosis of the renal artery." Both conditions require treatment from a urologist or a vascular surgeon.

Stenosis of the renal arteries: causes of pathology

The narrowing of the lumen of the peripheral arteries is attributed to the pathologies of the vascular system. There are different causes of stenosis. The most common of these is atherosclerosis. As is known, in most cases it is observed in people who are overweight, leading a sedentary lifestyle or suffering from diabetes. Atherosclerosis can develop for a long time. However, it is rarely diagnosed before the onset of symptoms of blockage of the arteries. Other causes of stenosis include:

  1. Fibromuscular dysplasia. By this term is meant a congenital genetic defect, as a result of which there is a lack of muscle fibers in the vessel wall. Pathology is observed in women of any age.
  2. Aneurysm of the arteries of the kidneys.
  3. Tumors of peripheral vessels.
  4. Congenital and acquired vasculitis.
  5. The compression of the renal artery by neoplasms originating from the tissues of neighboring organs.

The listed reasons are encountered in rare cases. Therefore, to their diagnosis, they proceed only after the exclusion of atherosclerosis.

The mechanism of development of hypertension

The main symptom of stenosis of the arteries of the kidneys is an increase in blood pressure. Therefore, for a given clinical syndrome, a renal system examination is necessary. How is stenosis of the renal arteries and arterial hypertension associated? In the increase of blood pressure two mechanisms participate:

  1. Activation of the renin-angiotensin system. Under the influence of these biological substances, the narrowing of arterioles develops. As a result, the resistance of peripheral vessels increases. Thus, the blood pressure in the arteries rises.
  2. Action of aldosterone. This hormone is produced in the cortex of the adrenal glands. Normally, it is present in the body all the time. However, with stenosis of the artery, its production increases. Because of the excessive amount of aldosterone, the body accumulates liquid and sodium ions. This, in turn, also causes an increase in blood pressure.

As a result of chronic hypertension, there are changes in the cardiovascular system. The left ventricle is gradually hypertrophied and stretched. This is another reason for hypertension.

Stenosis of the renal artery: symptoms of the disease

The narrowing of the arteries of the kidneys leads to many consequences. Symptoms of stenosis are not immediately apparent, but only with severe occlusion. In this case, conservative treatment is not always effective. In addition to vascular disorders, stenosis of the artery leads to ischemic changes in the kidney. As a result, the filtration and concentration function of the organ suffers. Given this, it is possible to identify 2 clinical syndromes that develop with stenosis. The first is arterial hypertension. This syndrome is characterized by a number of clinical manifestations. Among them:

  1. Increase in blood pressure. It can be either episodic or permanent. Especially important for diagnosis is an increase in diastolic blood pressure (more than 100 mm Hg).
  2. The appearance of noise in the ears.
  3. Dizziness.
  4. Nausea, which has no connection with food intake.
  5. The flashing of "flies" before the eyes.
  6. Headache in the temples, forehead.
  7. Irritability.

The second clinical syndrome is ischemic nephropathy. Due to the violation of renal blood flow, the "nutrition" of the organ stops. Especially dangerous is bilateral stenosis of the renal arteries. Hypertension is a condition that can be partially controlled by medication. Unfortunately, severe ischemia of the body can not be corrected with the help of drugs. Symptoms of "oxygen starvation" of the kidney include: pain in the lumbar region, changes in the direction of urination. Often there is a decrease in the amount of secreted fluid, a general weakness. In urine, there may be an admixture of blood, a cloudy sediment.

Diagnostics

Only after the examination it is possible to diagnose "stenosis of the renal arteries". Diagnosis of pathology includes the collection of complaints and anamnesis of the disease, laboratory tests and instrumental methods. Most often, the leading syndrome is arterial hypertension, which is not suited to antihypertensive therapy. Also, patients can complain of unpleasant sensations in the lower back (from one or two sides), a change in the nature of urination. The survey plan includes:

  1. UAC and general urinalysis.
  2. ECG.
  3. Blood chemistry. The disease can be suspected with an increase in the level of creatinine and urea.
  4. Kidney ultrasound.
  5. Special tests: urine analysis by Nechiporenko, Zimnitsky.
  6. X-ray contrast study of vessels - renography.
  7. Dopplerography of the renal arteries.
  8. Angiography.
  9. CT and MRI.

Differential diagnostics

Given that the hypertensive syndrome is the leading, stenosis of the renal artery is differentiated from the pathologies of the heart, atherosclerosis of the aorta. Also, the symptoms may resemble Isenzo-Cushing's disease and pheochromocytoma.

If signs of ischemic nephropathy prevail, then stenosis is differentiated with inflammatory kidney pathologies. These include pyelo- and glomerulonephritis. Also, similar symptoms can occur with complications of diabetes mellitus.

Conservative therapy for renal artery stenosis

Treatment of renal artery stenosis begins with conservative methods. In hypertension caused by narrowing of the renal vessels, a combination of several drugs is necessary. Preference is given to inhibitors of the angiotensin-converting enzyme. But these drugs should not be taken with a pronounced atherosclerotic vascular lesion. The combination consists of the following groups of medicines:

  1. Beta-blockers. These include preparations Metoprolol, Coronal, Bisoprolol.
  2. Loop diuretics. The drug of choice is the drug "Furosemide".
  3. Calcium channel blockers. Among them - medicines "Verapamil", "Diltiazem".

In addition, the patient must take the drugs needed to treat the underlying disease (atherosclerosis, diabetes mellitus).

Surgical treatment of stenosis

Unfortunately, in most cases, hypotensive therapy is ineffective. In addition, a decrease in blood pressure only aggravates ischemic nephropathy. Therefore, we must resort to prompt intervention. Depending on the extent of the lesion, the method of surgical treatment is chosen. Most often, the stenting of the artery, blood supply to the kidney. If the entire lumen of the vessel is obturated over a large extent, shunting is performed-the replacement of the vascular site with the graft. With the death of the kidney tissue, a nephrectomy is performed.

Prognosis after surgical treatment of stenosis

Regardless of which side was the lesion (stenosis of the left renal artery or right), the prognosis after the operation depends on compliance with the physician's recommendations and the patient's physical condition. Often, surgical treatment can achieve a positive result. After a few months, 60-70% of patients undergo normalization of arterial pressure.

Complications of renal stenosis

Unfortunately, the stenosis of the arteries of the kidneys is diagnosed only at a late stage of development. Therefore, you can not neglect the doctor's recommendations. After all, without proper treatment, serious complications can develop. Among them - myocardial infarction and ONMI on a background of hypertonic crisis, acute and chronic renal failure. If the surgery is not performed in time, the patient may lose the organ.

Prevention

Prophylactic measures include a constant monitoring of blood pressure in the presence of complaints of dizziness and noise in the ears, refusal from smoking and alcoholic beverages. To avoid the progression of atherosclerosis, it is necessary to observe a special hypocholesterin diet, to lead an active lifestyle. Some patients should take special drugs - statins.

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