Renal Artery Stenosis

Renal Artery Stenosis - Renal Artery Stenosis Defined as a...

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Renal Artery Stenosis
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± Defined as a narrowing of one or both renal arteries or their branches ± Most commonly caused by atherosclerosis ± Less frequently caused by fibromuscular dysplasia ± 90% of lesions are ostial ± Prevalence increases with age
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Dworkin et al. NEJM 2009
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± Prevalence of clinically manifested atherosclerotic renal-artery stenosis in the Medicare population is 0.5% overall and 5.5% among patients with chronic kidney disease ± patients with renal-artery stenosis had significantly increased rates of CKD (25%, vs. 2%), CAD (67% vs. 25%), stroke (37% vs. 12%), and PVD (56% vs. 13%), Karla et al. Kidney Int 2005
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Increased risk of cardiovascular events may be due to: ¾ concomitant atherosclerosis in other vascular beds ¾ activation of the renin–angiotensin– aldosterone and sympathetic nervous systems ¾ associated renal insufficiency Dworkin et al. NEJM 2009
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Classic clues suggestive of RAS ± The onset of stage 2 hypertension after 50 years of age ± Hypertension associated with renal insufficiency ± Hypertension with repeated hospital admissions for heart failure ± Drug-resistant hypertension Dworkin et al. NEJM 2009
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Diagnosis
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Dworkin et al. NEJM 2009
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± 51 hypertensive patients were studied: ¾ 16 with Uni-RAS ¾ 16 with Bi-RAS ¾ 19 essential hypertensive pts with normal arteries ± Nineteen normotensive individuals were also studied ± Ald/PRA lower than 0.5 and Ald/PRA higher than 3.7 to have the best sensitivity and specificity to detect Uni-RAS and Bi-RAS, respectively Kotliar et al. Journal of Hypertension Feb 2010
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Kotliar et al. Journal of Hypertension Feb 2010
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Kotliar et al. Journal of Hypertension Feb 2010
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Mechanisms of kidney injury
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± The decrease in renal perfusion and function does not correlate with the angiographic degree of stenosis ± The decrease in renal perfusion in patients with atherosclerotic RAS exceeds that incurred in age- and treatment-matched
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Renal Artery Stenosis - Renal Artery Stenosis Defined as a...

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