Renal
Vascular Disease
Renal
vascular disease is the name given to a variety
of complications that affect the arteries and
veins of the kidneys. These complications affect
the blood circulation of the kidneys, and may
cause damage to the tissues of the kidneys, kidney
failure, and/or high blood pressure.
Vascular
conditions affecting the renal arteries and veins
include the following:
- renal artery stenosis
Renal artery stenosis is a blockage of an artery
to the kidneys. It may cause kidney failure
and hypertension (high blood pressure).
- renal artery thrombosis
Renal artery thrombosis is the formation of
a clot in a renal artery. A thrombosis of a
renal artery may cause kidney failure because
of blocked blood flow to the kidney.
- renal artery aneurysm
A renal artery aneurysm is a bulging, weakened
area in the wall of an artery to the kidney.
Most of these aneurysms are small (less than
two centimeters, or about three-quarters of
an inch) and without symptoms. Renal artery
aneurysms are uncommon, and are generally discovered
during diagnostic procedures performed in relation
to other conditions.
- atheroembolic renal
disease
Atheroembolic renal disease occurs when a piece
of plaque from the aorta and/or other large
arteries breaks off and travels through the
bloodstream, blocking small arteries such as
the renal arteries. Atheroembolic renal disease
is becoming a common cause of renal insufficiency
(poor kidney function) in the elderly.
- renal vein thrombosis
A renal vein thrombosis is the formation of
a clot in a vein to the kidney.
Renal
vascular disease is often associated with hypertension
(high blood pressure). Hormones which influence
blood pressure are affected by kidney function.
Decreased blood flow to the kidney(s) as a result
of renal vascular disease may cause an excessive
amount of renin to be produced. Renin is a powerful
hormone that increases blood pressure.
The
cause of renal vascular disease will depend on
the specific
condition involved:
Risk
factors for renal vascular disease include:
- age
- female gender
- atherosclerosis
- hypertension, particularly
new onset of hypertension in an older person
- smoking
- high cholesterol
- diabetes
A risk
factor is anything that may increase a person's
chance of developing a disease. It may be an activity,
such as smoking, diet, family history, or many
other things. Different diseases have different
risk factors.
Although
these risk factors increase a person's risk,
they do not necessarily cause the disease. Some
people with one or more risk factors never develop
the disease, while others develop disease and
have no known risk factors. Knowing your risk
factors to any disease can help to guide you into
the appropriate actions, including changing behaviors
and being clinically monitored for the disease.
Symptoms
of renal vascular disease vary depending on the
type of disease and degree of involvement present.
Symptoms of various types of renal vascular disease
include, but are not limited, to the following:
| Type
of Renal Vascular Disease |
Symptoms
|
| Renal
Artery Stenosis |
- sudden onset
of hypertension before age 50 suggests
fibromuscular dysplasia-related stenosis
- sudden onset
of hypertension at or after age 50 suggests
stenosis caused by atherosclerosis
- hypertension
not responsive to three or more blood
pressure medications
- increased urea
(a waste product excreted by the kidneys)
in the blood
- unexplained
kidney failure
- sudden kidney
failure when first taking an angiotensin-converting
enzyme (ACE) inhibitor medication for
blood pressure and/or heart treatment
|
| Renal
Artery Thrombosis |
acute
(sudden) complete blockage:
- sudden onset
of flank (between the ribs and the upper
border of the hip bone) pain and tenderness
- fever
- blood in the
urine
- nausea and/or
vomiting
- sudden decrease
in kidney function
- hypertension
more gradual or
incomplete blockages:
- may be asymptomatic
(without symptoms) and go undetected
|
| Renal
Artery Aneurysm |
- generally asymptomatic
- hypertension
may be present in up to 90 percent of
persons with a renal artery aneurysm
- dissecting
aneurysms (caused by a tear in the inner
layer of the artery wall) may cause
flank pain and blood in the urine
|
Atheroembolic Renal Disease |
- skin lesions
such as purpura (a type of rash in which
blood cells leak into the skin or mucous
membranes)
- mottling (discolored
areas) of the toes and feet
- kidney failure
(either sudden or occurring over a longer
period of time)
- abdominal pain
- diarrhea
- confusion
- weight loss
- fever
- muscle aches
|
| Renal
Vein Thrombosis |
chronic
(over a period of time) onset:
acute (sudden)
onset:
- persistent
severe flank that may be spasmodic (with
spasms) at times
- soreness in
the area over the kidney, between the
ribs and the backbone
- decreased kidney
function
|
The symptoms of renal vascular disease may resemble
other medical conditions or problems. Always consult
your physician for a diagnosis.
In addition
to a complete medical history and physical examination,
diagnostic procedures for renal vascular disease
may include any, or a combination, of the following:
- arteriogram (Also
called an angiogram.) - an x-ray image of the
blood vessels used to evaluate various conditions,
such as aneurysm, stenosis (narrowing of the
blood vessel), or blockages. A dye (contrast)
will be injected through a thin flexible tube
placed in an artery. This dye makes the blood
vessels visible on x-ray.
- duplex ultrasound
- a type of vascular ultrasound procedure done
to assess blood flow and the structure of the
leg veins. The term "duplex" refers
to the fact that two modes of ultrasound are
used - Doppler and B-mode. The B-mode transducer
(like a microphone) obtains an image of the vessel
being studied. The Doppler probe within the
transducer evaluates the velocity and direction
of blood flow in the vessel.
- renography - a specialized
radiology procedure used to assess the function
and structure of the kidneys. Renography is
a type of nuclear radiology procedure. This
means that a tiny amount of a radioactive substance
is used during the procedure to assist in the
examination of the kidneys.
- magnetic resonance
angiography (MRA) - a noninvasive diagnostic
procedure that uses a combination of magnetic
resonance technology (MRI) and intravenous (IV)
contrast dye to visualize blood vessels. Contrast
dye causes blood vessels to appear opaque on
the MRI image, allowing the physician to visualize
the blood vessels being evaluated.
Specific
treatment will be determined by your physician
based on:
- your age, overall health
and medical history
- extent of the disease
- your signs and symptoms
- your tolerance for
specific medications, procedures, or therapies
- expectations for the
course of the disease
- your opinion or preference
Treatment
will also vary depending on the type of renal
vascular disease that is present.
| Type
of renal vascular disease |
Treatment
|
| Renal
Artery Stenosis |
medical
treatment:
- angiotensin-converting
enzyme (ACE) inhibitor medication may
be prescribed to treat hypertension
in patients with fibromuscular dysplasia
- antihypertensive
medications may be used to treat high
blood pressure
- in stenosis
caused by atherosclerosis, medications
to lower cholesterol may be prescribed
- treatment of
related medical conditions such as diabetes
surgical treatment:
- endovascular
procedures such as angioplasty (the
opening of a renal artery using a balloon
or other method) or placement of a stent
(a tiny expandable metal coil placed
inside an artery to keep the artery
open)
- open surgical
procedures to bypass the occluded renal
artery. There are several variations
of such procedures.
|
| Renal
Artery Thrombosis |
Treatment
of a renal artery thrombosis depends on
the type (acute or chronic) of thrombosis,
and the length of time since the thrombosis
occurred.
In acute situations,
thrombolytic ("clot-busting")
medication may be infused into the renal
artery for several hours to several days
to break up the clot.
Surgery to remove
the clot or bypass the artery may be performed
in some situations. |
| Renal
Artery Aneurysm |
Treatment
of a renal artery aneurysm depends on
factors such as size and location of the
aneurysm and whether or not symptoms are
present. Certain types of small (less
than two centimeters, or about three-quarters
of an inch) aneurysms may not be treated,
but may be observed for growth or development
of other complications.
Larger aneurysms
(greater than two centimeters or three-quarters
of an inch), dissecting aneurysms, aneurysms
causing kidney ischemia (lack of blood
flow to the kidney tissue) and hypertension,
aneurysms that are growing larger, and
aneurysms causing symptoms may be treated
surgically.
Because of the
increased risk for rupture (bursting),
a renal artery aneurysm in a pregnant
woman or a woman of child-bearing age
will generally be treated surgically. |
| Atheroembolic
Renal Disease |
Treatment
of atheroembolic renal disease depends
on the extent of the disease and the individual
situation.
Medical treatment
may include medications to reduce cholesterol,
blood pressure, and other related medical
conditions, such as diabetes.
Surgical treatment
may include:
- endovascular
procedures such as angioplasty (the
opening of a renal artery using a balloon
or other method) or placement of a stent
(a tiny expandable metal coil placed
inside an artery to keep the artery
open)
- open surgical
procedures to bypass the occluded renal
artery. There are several variations
of such procedures.
|
| Renal
Vein Thrombosis |
Renal
vein thrombosis is generally treated medically
with anticoagulant (keeps the blood from
clotting) medication. Anticoagulants may
be given intravenously (IV) for several
days, then given orally for several weeks
up to an indefinite period of time. |
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