Skip to Main Content
Home Books Quick Dx & Rx: Cardiology

Hypertension, Renovascular

  • Sections
  • Print
  • Get Citation

    Citation

    Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Please consult the latest official manual style if you have any questions regarding the format accuracy.

    AMA Citation
    Hypertension, Renovascular. In: Crawford MH, Aras M, Sanchez JM. Crawford M.H., & Aras M, & Sanchez J.M.(Eds.),Eds. Michael H. Crawford, et al.eds. Quick Dx & Rx: Cardiology. McGraw-Hill; Accessed July 13, 2020. https://accesscardiology.mhmedical.com/content.aspx?bookid=2470&sectionid=196385050
    APA Citation
    Hypertension, renovascular. Crawford MH, Aras M, Sanchez JM. Crawford M.H., & Aras M, & Sanchez J.M.(Eds.),Eds. Michael H. Crawford, et al. (2018). Quick Dx & Rx: Cardiology. McGraw-Hill. https://accesscardiology.mhmedical.com/content.aspx?bookid=2470&sectionid=196385050
    MLA Citation
    "Hypertension, Renovascular." Quick Dx & Rx: Cardiology Crawford MH, Aras M, Sanchez JM. Crawford M.H., & Aras M, & Sanchez J.M.(Eds.),Eds. Michael H. Crawford, et al. McGraw-Hill, 2018, https://accesscardiology.mhmedical.com/content.aspx?bookid=2470&sectionid=196385050.

    Download citation file:

    RIS (Zotero)
    EndNote
    BibTex
    Medlars
    ProCite
    RefWorks
    Reference Manager
    Mendeley
    © Copyright
  • Tools
  • Search Book
  • Clip
Top

KEY FEATURES

ESSENTIALS OF DIAGNOSIS

  • Age 30 or after age 55

  • Abdominal or flank systolic and diastolic bruits, or evidence of peripheral vascular disease

  • Unilateral small kidney on any imaging study

  • Hypertension resistant to 3 medications

  • Worsening renal function after an angiotensin-converting enzyme inhibitor

  • Elevated plasma renin activity with or without captopril administration

  • Imaging evidence of renal artery occlusive disease

GENERAL CONSIDERATIONS

  • Renal vascular disease is an unusual cause of hypertension but is potentially curable

  • Renal vascular hypertension usually results from obstruction of 1 main artery in 1 kidney

  • The most common cause in women < age 30 is fibromuscular hyperplasia

  • The most common cause in men > age 55 is atherosclerosis

CLINICAL PRESENTATION

SYMPTOMS AND SIGNS

  • No specific symptoms or signs

PHYSICAL EXAM FINDINGS

  • Advanced eye fundoscopic changes are common

  • Renal bruits may be heard

  • Evidence of other vascular disease

DIFFERENTIAL DIAGNOSIS

  • Essential hypertension

  • Renal parenchymal disease

  • Other causes of secondary hypertension

DIAGNOSTIC EVALUATION

LABORATORY TESTS

  • High plasma renin activity and plasma aldosterone levels

ELECTROCARDIOGRAPHY

  • Left heart chamber enlargement may be seen

IMAGING STUDIES

  • CT or magnetic resonance angiography of the renal arteries

DIAGNOSTIC PROCEDURES

  • Renal arteriogram is almost always diagnostic and can be followed by stenting if appropriate

TREATMENT

CARDIOLOGY REFERRAL

  • Refractory hypertension

  • Suspected cardiac disease

  • Planned renal artery stenting

HOSPITALIZATION CRITERIA

  • Complications of hypertension

  • Planned procedure

MEDICATIONS

  • Pharmacologic therapy if hypertension is mild or readily controlled

THERAPEUTIC PROCEDURES

  • Percutaneous angioplasty with or without stenting

SURGERY

  • Surgical repair or nephrectomy

MONITORING

  • Blood pressure

  • ECG in hospital as appropriate

DIET AND ACTIVITY

  • Low-sodium diet, limited alcohol intake

  • Exercise as tolerated

ONGOING MANAGEMENT

HOSPITAL DISCHARGE CRITERIA

  • Resolution of problem

  • Definitive procedure or surgery

FOLLOW-UP

  • One month, then 3 months, 6 months, yearly after procedure or surgery

COMPLICATIONS

  • Acute pulmonary edema

  • Rapid decline in renal function

  • Accelerated or malignant hypertension

  • Restenosis can occur after angioplasty or stenting

  • Persistent hypertension may occur after successful relief of arterial obstruction

PROGNOSIS

  • Excellent with correction of the vascular obstruction

PREVENTION

  • Preventive measures for atherosclerosis

RESOURCES

...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MHE Privacy Center Close