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Renovascular Hypertension

Boris Hlebec. Renovascular Hypertension. Contents. What is it ? Who gets it ? What causes it ? What are the symptoms ? How is it diagnosed ? What is the treatment ? How can you prevent it ? ( C an you ?). What is it ?. Hypertension

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Renovascular Hypertension

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  1. Boris Hlebec Renovascular Hypertension

  2. Contents • What is it ? • Who gets it ? • What causes it ? • What are the symptoms ? • How is it diagnosed ? • What is the treatment ? • How can you prevent it ? (Can you ?)

  3. What is it ? • Hypertension • Mean arterial pressure consistently > 110 mmHg • (Dia >90 ; Sys >140) • Secondary hypertension: • identifiable cause • Renovascular: • hardening and stenosis of the renal artery

  4. Who gets it ? • 6 out of 100,000 people • Age of onset depends upon cause • Men: >45 years => Atherosclerosis • Women : <45 years => Fibromuscular dysplasia • 10% of children with fibromuscular dysplasia

  5. Some risk factors • Smoking • High salt intake • Obesity • Stress • Heavy metals (not music) 

  6. What causes it ? • Renal ischemia ! • Atherosclerosis • Fibromuscular dysplasia • Injury • Tumour • Clots • Whatever that might narrow the renal artery

  7. How does that affect blood pressure ? • Renin-Angiotensin-Aldosterone System • Blood volume => cardiac output • Systemic vascular resistance BP = CO x SVR

  8. Kidney – a selfish bastard

  9. A – Renal corpuscleB – Proximal tubuleC – Distal convoluted tb.D – Juxtaglomerular app.1. Basal lamina2. Bowman's capsule – parietal layer 3. Bowman's capsule – visceral layer3a. Pedicels (podocytes)3b. Podocyte 4. Bowman's space 5a. Mesangium – iIntraglomerular cell5b. Mesangium – extraglomerular cell 6. Juxtaglomerular cells 7. Macula densa 8. Myocytes 9. Afferent arteriole10. Glomerulus Capillaries11. Efferent arteriole RAAS

  10. 3 main stimuli for renin release: • sympathetic nerve • β1-adrenoceptors • renal artery hypotension • systemic hypotension or renal artery stenosis • juxtaglomerular apparatus • decreased sodium delivery to the distal tubules • macula densa

  11. 10 8

  12. Angiotensin II • Constricts resistance vessels (via AII [AT1] receptors) thereby increasing systemic vascular resistance • Adrenal cortex releases aldosterone => increase sodium and fluid retention • Release of vasopressin (ADH) from the posterior pituitary = water retention • Stimulates thirst centers within the brain • Facilitates noradrenaline release from sympathetic nerve endings and inhibits norepinephrine re-uptake by nerve endings, thereby acting as a sympathomimetic agent • Stimulates cardiac hypertrophy and vascular hypertrophy

  13. Symptoms • High blood pressure ( Sherlock) • all the following complications: • Headache • Fatigue • Nausea and vomiting • Chest pain • Vision problems, confusion, anxiety • Excessive perspiration, pale or reddened skin • Sudden pain in the side and bloody urine – CLOT! • No symptoms at all

  14. Diagnosis • Severely high blood pressure that is difficult to control • Vascular murmur over left or right lumbar and/or periumbilical regions of abdomen • bruit • Ultrasound • Angiography • Levels of renin production

  15. Fibromuscular dysplasia (DSA)

  16. Treatment • Lifestyle changes • Medication • ACE inhibitors !!!!! • ATII-R blockers !!!!! • Beta blockers • Ca antagonists • Catheterisation (baloon) - MOVIE • Surgery • Bypass • Renectomy

  17. Literature • Pathophysiology: Kovač, Marušić, Gamulin (2005) • Guyton’s physiology (2004) • Wikipedia • http://www.hmc.psu.edu/healthinfo/r/renovascularhypertension.htm Mentor: A. Žmegač Horvat

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