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Zhang Y, Wang Y, Ma N, Li Y, Li Y, Ren J. Application of simple ultrasound Doppler hemodynamic parameters in the diagnosis of severe renal artery stenosis in routine clinical practice. Quant Imaging Med Surg 2023; 13:8042-8052. [PMID: 38106270 PMCID: PMC10722057 DOI: 10.21037/qims-23-605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/21/2023] [Indexed: 12/19/2023]
Abstract
Background Doppler ultrasound (DUS) is recommended in first-line imaging for the diagnosis of renal artery stenosis (RAS). However, the correct selection of Doppler direct or indirect parameters and their optimal thresholds remain controversial. This study explored simple ultrasound Doppler parameters to diagnose severe RAS (RAS ≥70%) in routine clinical practice. Methods In this retrospective study, patients with clinically suspected renovascular hypertension who first underwent renal artery DUS and contrast-enhanced ultrasound (CEUS) and subsequent digital subtraction angiography (DSA) or computed tomography angiography (CTA) were consecutively included. Clinical characteristics and ultrasound Doppler hemodynamic parameters were collected, including peak systolic velocity (PSV), the ratio of the peak velocities in the renal artery and the aorta (RAR), the ratio of the peak velocities in the renal artery and the segmental artery (RSR), and the ratio of the peak velocities in the renal artery and the interlobar artery (RIR). All enrolled patients were divided into two groups based on the degree of diameter reduction: a severe stenosis group (diameter reduction ≥70%) and a non-severe stenosis group (diameter reduction <70%). Logistic regression analysis was performed to determine the independent predictors for severe stenosis. Receiver operating characteristic curves and areas under the curve were used to evaluate the diagnostic performance of the ultrasound Doppler parameters. Results A total of 85 patients (106 renal arteries) with RAS were included in this study. The optimal thresholds of PSV in the main renal artery and the PSV ratios for diagnosing severe RAS obtained via receiver operating characteristic curves were 249.5 cm/s for PSV, 2.94 for RAR, 5.1 for RSR, and 7.5 for RIR. The areas under the curve of PSV and the ratios all exhibited good diagnostic efficiency (all >0.8). The combination of these four Doppler variables demonstrated a significant benefit to the overall diagnostic value compared with any factor alone [area under the curve (AUC) =0.962; 95% confidence interval (CI): 0.906-0.989; P<0.05]. The combination of PSV and RSR (AUC =0.925; 95% CI: 0.858-0.967) exhibited comparable diagnostic efficiency to the combination of four ultrasonographic variables (z statistic =1.882; P=0.06). Conclusions This simple and accurate method to evaluate severe RAS based on the velocity obtained via basic DUS may facilitate the detection of severe RAS in the majority of medical institutions and provide a reliable basis for the selection of proper candidates for further angiography or revascularization.
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Affiliation(s)
- Yuewei Zhang
- Department of Ultrasound, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Wang
- Department of Ultrasound, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Na Ma
- Department of Ultrasound, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Li
- Department of Ultrasound, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongjun Li
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Junhong Ren
- Department of Ultrasound, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Song X, Fu Y, Lai Z, Di X, Zeng R, Shao J, Ni L, Liu Z, Song X, Ye W, Liu C, Liu B, Zheng Y, Chen Y. Drug-coated balloon for treatment of non-atherosclerotic renal artery stenosis-a multi-center study. BMC Cardiovasc Disord 2023; 23:510. [PMID: 37845604 PMCID: PMC10577992 DOI: 10.1186/s12872-023-03484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/30/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Renal artery stenosis (RAS) is a significant reason for secondary hypertension. Impaired renal function and subsequent cardiopulmonary dysfunction could also occur. Patients of non-atherosclerotic RAS has a relatively young age and long life expectancy. Revascularization with percutaneous transluminal angioplasty (PTA) is a viable treatment option. However, restenosis is unavoidable which limits its use. Drug-coated balloon (DCB) has been proven to be effective in restenosis prevention in femoropopliteal arterial diseases and in patients with renal artery stenosis. And PTA for Renal artery fibromuscular dysplasia is safe and clinically successful. Therefore, we could speculate that DCB might have potential efficacy in non-atherosclerotic RAS treatment. METHODS AND ANALYSIS This will be a randomized multi-center-controlled trial. Eighty-four eligible participants will be assigned randomly in a 1:1 ratio to the control group (plain old balloon, POB) and the experimental group (DCB). Subjects in the former group will receive balloon dilatation alone, and in the latter group will undergo the DCB angioplasty. The DCB used in this study will be a paclitaxel-coated balloon (Orchid, Acotec Scientific Holdings Limited, Beijing, China). Follow-up visits will be scheduled 1, 3, 6, 9, and 12 months after the intervention. Primary outcomes will include controlled blood pressure and primary patency in the 9-month follow-up. Secondary outcomes will include technical success rate, complication rate, and bail-out stenting rate. TRIAL REGISTRATION ClinicalTrials.gov (number NCT05858190). Protocol version V.4 (3 May 2023).
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Affiliation(s)
- Xitao Song
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Yining Fu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Zhichao Lai
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Xiao Di
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Rong Zeng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Leng Ni
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Zhili Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Xiaojun Song
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Wei Ye
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Changwei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China
| | - Yuexin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1st, Dongcheng District, Beijing, 100730, China.
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Kesav P, Manesh Raj D, John S. Cerebrovascular Fibromuscular Dysplasia - A Practical Review. Vasc Health Risk Manag 2023; 19:543-556. [PMID: 37664168 PMCID: PMC10473246 DOI: 10.2147/vhrm.s388257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023] Open
Abstract
Fibromuscular dysplasia (FMD) is a rare idiopathic, segmental, noninflammatory and nonatherosclerotic arteriopathy of medium-sized arteries. It is classically considered to be a disease of young and middle adulthood, with females more commonly affected than males. FMD is a systemic disease. Although historically considered to be rare, cerebrovascular FMD (C-FMD) has now been recognized to be as common as the renovascular counterpart. Extracranial carotid and vertebral arteries are the most commonly involved vascular territories in C-FMD with the clinical presentation determined by vessels affected. Common symptoms include headaches and pulsatile tinnitus, with transient ischemic attacks, ischemic stroke and subarachnoid or intracerebral hemorrhage constituting the more severe clinical manifestations. Cervical artery dissection involving carotids more often than vertebral arteries and intracranial aneurysms account for the cerebrovascular pathologies detected in C-FMD. Our understanding regarding C-FMD has been augmented in the recent past on account of dedicated C-FMD data from North American, European and other international FMD cohorts. In this review article, we provide an updated and comprehensive overview on epidemiology, clinical presentation, etiology, diagnosis and management of C-FMD.
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Affiliation(s)
- Praveen Kesav
- Department of Neurology, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Divya Manesh Raj
- Research Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Seby John
- Department of Neurology and Neuro Interventional Surgery, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Xu L, Shao J, Li K, Wang C, Lai Z, Ma J, Yu X, Du F, Chen J, Liu X, Yuan J, Liu B, Wang C. Renal perfusion improvement in the perioperative period after unilateral endovascular revascularization in patients with atherosclerotic renal artery stenosis. Front Cardiovasc Med 2023; 10:1193864. [PMID: 37502187 PMCID: PMC10369776 DOI: 10.3389/fcvm.2023.1193864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/12/2023] [Indexed: 07/29/2023] Open
Abstract
Background The clinical benefits of endovascular treatment in renal artery stenosis (RAS) remain controversial. This study used an intraoperative renal perfusion imaging technique, called flat-panel detector parenchymal blood volume imaging (FD-PBV), to observe the change in renal perfusion after endovascular treatment in RAS. Materials and methods In a prospective, single-center study, we assigned 30 patients with atherosclerotic RAS who underwent endovascular treatment between March 2016 and March 2021. The preoperative and postoperative results of renal perfusion, blood pressure, and renal function, were compared. Results Both median kidney volume (p < 0.001) and median preoperative mean density of contrast medium (MDCM) (p = 0.028) increased significantly after endovascular treatment. The ratio of postoperative and preoperative MDCM differed greatly among the patients. For patients with preoperative MDCM <304.0 HU (Subgroup A, 15 cases), MDCM significantly increased after treatment (p = 0.001) and 12 (80.0%) patients had more than 10% increase in renal perfusion. For patients who had relatively high preoperative renal perfusion (MDCM ≥304.0 HU, Subgroup B, 15 cases), preoperative and postoperative MDCM were similar (p = 0.776). On the other hand, the serum creatinine levels significantly decreased in Subgroup A (p = 0.033) and fewer antihypertensive drugs were used after endovascular revascularization (p = 0.041). The preoperative and postoperative creatinine levels and number of antihypertensive drugs were similar in Subgroup B. Conclusions During the perioperative period, RAS patients with relatively low preoperative renal perfusion levels had greater improvement in renal perfusion, renal function, and blood pressure control after endovascular treatment. The improvement of renal function needs to be confirmed by long-term follow-up.
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Affiliation(s)
- Leyin Xu
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Kang Li
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Chaonan Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Zhichao Lai
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Jiangyu Ma
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Xiaoxi Yu
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Fenghe Du
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Junye Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Xiaolong Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Jinghui Yuan
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Chunyang Wang
- Department of Urology, PLA General Hospital, Beijing, China
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Turner JM, Dmitriev M. Secondary Hypertension Overview and Workup for the Primary Care Physician. Med Clin North Am 2023; 107:739-747. [PMID: 37258011 DOI: 10.1016/j.mcna.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Secondary hypertension occurs in 5% to 10% of all patients with hypertension. Given the majority of patients with hypertension will not have a secondary cause, only select patients with specific characteristics should be screened. The causes include a range of abnormalities, some are quite rare, such as pheochromocytoma, while others are much more common, such as chronic kidney disease. When considering which disorders to test for, it is important to incorporate the clinical history, family history, and prevalence of each disease. Treatment is specific to the underlying cause and includes medications, procedures, surgery, and device therapies.
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Affiliation(s)
- Jeffrey M Turner
- Section of Nephrology, Yale University School of Medicine, 330 Cedar Street, BB114, New Haven, CT 06510, USA.
| | - Mikhail Dmitriev
- Department of Internal Medicine, Connecticut Institute for Communities (Danbury Hospital), Danbury, CT, USA
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Abi Doumet A, Bustos B, Garrell J, Salman M, Haider L. Fibromuscular Dysplasia Presenting as Acute Unilateral Renal Infarction: A Case Report and Review of Two Diseases. Cureus 2023; 15:e35933. [PMID: 37038580 PMCID: PMC10082588 DOI: 10.7759/cureus.35933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
Fibromuscular dysplasia (FMD) is a rare systemic vascular disease that has been found to present as a renal infarction (RI) in only a handful of cases. We present a case of a 53-year-old Vietnamese patient presenting for sharp, severe left-sided abdominal pain of two-day duration associated with a migraine headache. On presentation, she was afebrile, and her vital signs were stable. Laboratory investigations were significant for mildly elevated leukocytosis but were otherwise normal. CT abdomen and pelvis with contrast revealed a left-sided renal infarct. The patient was then admitted to the hospital and started on therapeutic anticoagulation. A transthoracic echocardiogram was obtained and revealed no vegetation. CT angiography of the abdomen was pursued and was significant for mild beading within the mid-right and left renal arteries, consistent with fibromuscular dysplasia. Our patient was diagnosed with renal infarction in the setting of fibromuscular dysplasia, a combination that has been reported only a few times. Interestingly, our patient also had mild FMD based on imaging, making it even more of an unusual cause of renal infarction. This case highlights the connection between these two diseases and the need for more studies to characterize the association between them.
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Artyszuk Ł, Symonides B, Gaciong Z, Cienszkowska K, Ludwiczak M, Wrzaszczyk M, Szmigielski CA. A new threshold for kidney asymmetry improves association with abnormal renal-aortic ratio for diagnosis of renal artery stenosis. Vasc Med 2022; 27:551-556. [PMID: 36190768 DOI: 10.1177/1358863x221118604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Renal artery stenosis (RAS) reflects more widespread atherosclerosis deposition and is associated with high morbidity and mortality. According to the guidelines, a discrepancy in the size of the kidneys of over 15 mm found in an ultrasound should initiate the RAS diagnostic algorithm. This study aims to find the optimal threshold for renal asymmetry that better reflects the frequency of a significantly abnormal renal-aortic ratio (RAR), justifying further RAS diagnostic workup, than the currently used cut-off of 15 mm difference in renal diameters. METHODS The analysis included 1175 patients (mean age: 52 years, IQR: 38-66, men/women: 597/578) who underwent Doppler ultrasonography screening of renal arteries with recorded kidney size and RAR calculation. Ultrasound features of RAS were defined as a RAR greater than 3.5 or signs of renal artery occlusion. Receiver operating characteristic (ROC) curves were created and analyzed for absolute differences in kidney size and abnormal RAR. We calculated the area under the curve (AUC) and optimal cut-off values for sensitivity and specificity analysis. RESULTS The final analysis included 169 patients with a significant difference in renal dimension. RAS features were met in 61 patients. According to ROC curve analysis, the optimal index of renal asymmetry was 12 mm. The sensitivity and specificity for this method were 82.0% and 83.3%, respectively, and AUC was 86.3%. CONCLUSION Changing the definition of a significant difference in kidney size from 15 mm to 12 mm increases sensitivity and specificity for abnormal RAR and this finding may accelerate the diagnosis of RAS.
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Affiliation(s)
- Łukasz Artyszuk
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Symonides
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Zbigniew Gaciong
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Cienszkowska
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Marta Ludwiczak
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Wrzaszczyk
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Cezary A Szmigielski
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
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Liu E, Zhao H, Liu C, Tan X, Luo C, Yang S. Research progress of moyamoya disease combined with renovascular hypertension. Front Surg 2022; 9:969090. [PMID: 36090342 PMCID: PMC9458923 DOI: 10.3389/fsurg.2022.969090] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Moyamoya disease (MMD) is an idiopathic cerebrovascular disease which was first described by Suzuki and Takaku in 1969. Moyamoya disease is a non-atherosclerotic cerebrovascular structural disorder. MMD has been found all over the world, especially in Japan, Korea, and China. In recent years, many reports pointed out that the changes of vascular stenosis in patients with moyamoya disease occurred not only in intracranial vessels, but also in extracranial vessels, especially the changes of renal artery. Renovascular hypertension (RVH) is considered to be one of the important causes of hypertension in patients with moyamoya disease. The pathogenesis of moyamoya disease combined with renovascular hypertension is still unclear, and the selection of treatment has not yet reached a consensus. This article reviews the latest research progress in epidemiology, RNF213 gene, pathomorphology, clinical characteristics and treatment of moyamoya disease combined with renovascular hypertension, in order to provide reference for clinical workers.
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Affiliation(s)
- Erheng Liu
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Heng Zhao
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Chengyuan Liu
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Xueyi Tan
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Chao Luo
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Shuaifeng Yang
- Department of Neurosurgery, The First People's Hospital of Yunnan Province, Kunming, China
- Correspondence: Shuaifeng Yang
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Yu MS, Xiang K, Haller ST, Cooper CJ. Renal Artery Interventions. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Babici D, Hindi F, Hanafy KA. Posterior reversible encephalopathy syndrome due to unilateral renal artery stenosis: A case report. Brain Circ 2022; 8:108-111. [PMID: 35909707 PMCID: PMC9336591 DOI: 10.4103/bc.bc_14_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/03/2022] Open
Abstract
A tricenarian female with a past medical history of status epilepticus secondary to posterior reversible encephalopathy syndrome (PRES) of unknown etiology presented with a 2-week history of double vision, dizziness, elevated blood pressure, and altered mental status. On hospital day 2, she experienced status epilepticus, during which her blood pressure rose to 240/160 from her baseline of around 140/90. The patient was subsequently intubated for airway protection and transferred to the intensive care unit, where she was started on a nicardipine drip. Due to her history of thrombotic microangiopathy, empiric treatment with plasma exchange and prednisone was started but discontinued when ADAMTS13 came back negative. Urine metanephrines also were found to be negative. Computed tomography angiography of the abdomen showed left renal artery stenosis and stent was placed. Remarkably, over the coming days, her blood pressure normalized, and her neurologic symptoms significantly improved. As a result, antihypertensive medications were titrated down, and the patient was finally provided with a cause of her repetitive, life-threatening episodes of PRES.
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Affiliation(s)
- Denis Babici
- Department of Neurology, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Fawzi Hindi
- Department of Neurology, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Khalid A Hanafy
- Department of Neurocritical Care, Marcus Neuroscience Institute, Boca Raton, Florida, USA
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Hicks CW, Clark TW, Cooper CJ, de Bhailís ÁM, De Carlo M, Green D, Małyszko J, Miglinas M, Textor SC, Herzog CA, Johansen KL, Reinecke H, Kalra PA. Atherosclerotic Renovascular Disease: A KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference. Am J Kidney Dis 2022; 79:289-301. [PMID: 34384806 PMCID: PMC9834909 DOI: 10.1053/j.ajkd.2021.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
The diagnosis and management of atherosclerotic renovascular disease (ARVD) is complex and controversial. Despite evidence from the ASTRAL (2009) and CORAL (2013) randomized controlled trials showing that percutaneous renal artery revascularization did not improve major outcomes compared with best medical therapy alone over 3-5 years, several areas of uncertainty remain. Medical therapy, including statin and antihypertensive medications, has evolved in recent years, and the use of renin-angiotensin-aldosterone system blockers is now considered the primary means to treat hypertension in the setting of ARVD. However, the criteria to identify kidneys with renal artery stenosis that have potentially salvageable function are evolving. There are also data suggesting that certain high-risk populations with specific clinical manifestations may benefit from revascularization. Here, we provide an overview of the epidemiology, diagnosis, and treatment of ARVD based on consensus recommendations from a panel of physician experts who attended the recent KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference on central and peripheral arterial diseases in chronic kidney disease. Most focus is provided for contentious issues, and we also outline aspects of investigation and management of ARVD that require further research.
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Immunomodulatory Potential of Diuretics. BIOLOGY 2021; 10:biology10121315. [PMID: 34943230 PMCID: PMC8698805 DOI: 10.3390/biology10121315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/25/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022]
Abstract
In this review, diuretics and their immunomodulatory functions are described. The effects on the immune response of this group of drugs are reported in patients suffering from hypertension and under experimental conditions involving animal models and cell line studies. The pathogenesis of hypertension is strongly connected to chronic inflammation. The vast majority of diuretics modulate the immune response, changing it in favor of the anti-inflammatory response, but depending on the drug, these effects may differ. This topic is significantly important in medical practice regarding the treatment of patients who have coexisting diseases with chronic inflammatory pathogenesis, including hypertension or chronic heart failure. In patients with metabolic syndrome, allergies, or autoimmune disorders, the anti-inflammatory effect is favorable, because of the overstimulation of their immune system. Otherwise, in the geriatric population, it is important to find the proper anti- and pro-inflammatory balance to avoid an enhancement of immune response suppression, which can result in reducing the risk of serious infections that can occur due to the age-diminished function of the immune system. This article is intended to facilitate the selection of an antihypertensive drug that depends on the patient's immune situation.
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Valentin B, Stabinska J, Reurik F, Tell C, Mewes AD, Müller-Lutz A, Antoch G, Rump LC, Wittsack HJ, Ljimani A. Feasibility of renal perfusion quantification by Fourier decomposition MRI. Magn Reson Imaging 2021; 85:3-9. [PMID: 34655728 DOI: 10.1016/j.mri.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 09/19/2021] [Accepted: 10/10/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the feasibility of perfusion measurements in the human kidney by Fourier decomposition MRI (FD-MRI). METHODS Renal perfusion measurements by FD-MRI and arterial spin labeling (ASL) were performed using a 1.5 T whole-body MR-scanner (Magnetom Avanto, Siemens Healthineers AG, Germany) in 15 healthy volunteers (mean age 33.0 ± 13.6 years). Five healthy volunteers were measured twice to evaluate the reproducibility. Besides, five patients with renal artery stenosis (RAS) (mean age 58.4 ± 16.2 years) were included in the study to evaluate potential clinical use of the FD-MRI for evaluating renal perfusion. For renal FD-MRI, coronal 2D-TrueFisp sequence (1 section; section thickness: 10 mm; FOV: 400 × 400 mm 2; TR/TE: 2.06/0.89 ms; 250 images; 0,36 s/image), for renal ASL, coronal FAIR-TrueFisp sequence (1 section; section thickness: 10 mm; FOV: 400 × 400 mm2; TR/TE 4.0/2.0 ms, TI 1200 ms, 30 averages; 8,32 s/average) were acquired without any triggering. Perfusion parameter maps of the kidneys were calculated for both methods. After manual segmentation, ROI-based analysis (whole kidney, cortex and medulla, respectively) was performed and the results were subsequently compared using the Student t-test. RESULTS The acquisition times were 1.30 min and 4.16 min, for renal FD-MRI and ASL, respectively. No significant difference in global renal perfusion (RBF) between both methods was detected (mean RBF in the right kidney: 308.4 ± 31.5 mL/100 mL/min for FD-MRI; 315.2 ± 41.1 for ASL; in the left kidney: 315.6 ± 32.8 mL/100 mL/min for FD-MRI; 310.2 ± 39.1 mL/100 mL/min for ASL, respectively). The results indicated good reproducibility of both considered methods. However, cortico-medullar differentiation was not possible by FD-MRI, probably due to lower SNR compared to ASL. Significant difference in the side-separated RBF were measured by FD-MRI as well as by ASL (p < 0.05) in patients with RAS. CONCLUSIONS FD-MRI is a novel, rapid approach for contrast-free perfusion quantification in the human kidney. Main advantage of this new method compared to ASL perfusion is the significant shorter acquisition time and lower dependency on patient's compliance. However, lower SNR of FD-MRI needs further improvement to make FD-MRI a competitive alternative to ASL.
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Affiliation(s)
- B Valentin
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - J Stabinska
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - F Reurik
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - C Tell
- University Dusseldorf, Medical Faculty, Department of Nephrology, D-40225 Dusseldorf, Germany
| | - A D Mewes
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - A Müller-Lutz
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - G Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - L C Rump
- University Dusseldorf, Medical Faculty, Department of Nephrology, D-40225 Dusseldorf, Germany
| | - H J Wittsack
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - A Ljimani
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
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Gunawardena T. Atherosclerotic Renal Artery Stenosis: A Review. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 9:95-99. [PMID: 34638148 PMCID: PMC8598311 DOI: 10.1055/s-0041-1730004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Renal artery stenosis (RAS) is associated with hypertension and renal impairment. Atherosclerosis is the leading etiologic factor which accounts for >90% of the cases. Those with atherosclerotic RAS (ARAS) tend to have concomitant atherosclerosis in other vascular beds, so they are at a high risk of adverse coronary and cerebrovascular events. Management of ARAS is controversial, with limited indications for revascularization. In this review, the author aims to discuss the pathophysiology, natural history, diagnosis, and management of ARAS.
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Affiliation(s)
- Thilina Gunawardena
- Department of Vascular and Transplant Surgery, National Hospital of Colombo, Sri Lanka
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15
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Gil Llopis C, Valls Serral A, Beltrán Catalán S. [Pickering syndrome: acute heart failure with an unexpected actor]. HIPERTENSION Y RIESGO VASCULAR 2021; 38:197-200. [PMID: 34210635 DOI: 10.1016/j.hipert.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022]
Abstract
Pickering's syndrome is a clinical entity described in 1988 that consists of the presentation of recurrent and predominantly nocturnal acute flash pulmonary oedema and arterial hypertension secondary to bilateral renal artery stenosis or unilateral in single-kidney patients. We describe the case of a 74-year-old man who, after percutaneous exclusion treatment of an aortic infrarenal aneurysm, developed Pickering syndrome due to haemodynamic obstruction of the left renal artery because of the aortic endoprosthesis; with satisfactory clinical evolution after revascularization.
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Affiliation(s)
- C Gil Llopis
- Hospital Universitario Dr. Peset, Valencia, España.
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16
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Munasinghe A, Wedisinghe L, Han T, Narayan R. Bilateral renal artery stenosis due to fibromuscular dysplasia presenting as superimposed pre-eclampsia. BMJ Case Rep 2021; 14:14/5/e237759. [PMID: 34039539 DOI: 10.1136/bcr-2020-237759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Renal vascular hypertension is a diagnosis that needs to be entertained in the setting of refractory, otherwise unexplained hypertension in pregnancy. Conclusive diagnosis of the condition is made by the use of angiography, which confers only a low, safe dose of radiation to the fetus, especially after the first trimester. Percutaneous angioplasty is effective in treating this condition and is best performed postnatally to avoid fetal exposure to ionising radiation. While it could be managed pharmacologically, more refractory cases in pregnancy may be offered interventional treatment.
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Affiliation(s)
- Aruna Munasinghe
- Department of Obstetrics and Gynaecology, Rockhampton Hospital, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Lilantha Wedisinghe
- Department of Obstetrics and Gynaecology, Rockhampton Hospital, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Thin Han
- Department of Medicine and Nephrology, Rockhampton Hospital and University of Queensland Rural Clinical School-Rockhampton Campus, Rockhampton, Queensland, Australia
| | - Rajit Narayan
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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17
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Non-contrast MR angiography versus contrast enhanced MR angiography for detection of renal artery stenosis: a comparative analysis in 400 renal arteries. Abdom Radiol (NY) 2021; 46:2064-2071. [PMID: 33136181 DOI: 10.1007/s00261-020-02836-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE In this study, we compared non-contrast MR angiography (NC-MRA) with conventional 3D contrast-enhanced MRA (CE-MRA) in patients suspected to have renal artery stenosis (RAS). METHODS From March 2014 to March 2020, patients who were evaluated for RAS and had a glomerular filtration rate > 30 ml/min/1.73 m2 underwent MR imaging on a 3T MR Scanner (Signa Hdxt General Electrics, Milwaukee, USA) using a Torso PA coil. The NC-MRA sequence was performed using a 3D fat-suppressed inflow inversion recovery balanced steady state free precession (SSFP) sequence (Inhance 3D Inflow IR, GE Medical) whereas the CE-MRA sequence was a 3D fast spoiled gradient echo (FSPGR). Overall quality of images was rated 1 to 4. Stenosis was reported as grade 1 (Normal), 2 (< 50% narrowing), 3 (> 50% narrowing) and 4 (Total occlusion). Grade 3 and 4 were considered haemodynamically significant. RESULTS During the study period, 201 patients were enrolled (400 renal arteries). For hemodynamically significant (grade 3/4) stenosis, NC-MRA correctly diagnosed 72 patients (95 arteries) while in 2 patients (2 arteries), NC-MRA underdiagnosed the stenosis as grade 2 (these were found to have grade 3 stenosis on CE-MRA). The kappa value of agreement between NC-MRA and CE-MRA for detection of RAS showing excellent agreement (p < 0.001). CONCLUSION In one of the largest series of patients so far, we found that NC-MRA is a viable alternative to CE-MRA for detection of RAS, highly correlating with CE-MRA for grade of stenosis and with additional advantage of lack of gadolinium based contrast agents toxicity.
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18
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Dao K, Patel P, Pollock E, Mangano A, Gosal K. Ischemic Nephropathy Following Occlusion of Abdominal Aortic Aneurysm Graft: A Case Report. Cureus 2021; 13:e13799. [PMID: 33842171 PMCID: PMC8033647 DOI: 10.7759/cureus.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this report, we present a case of a 55-year-old female with a past medical history of abdominal aortic aneurysm (AAA) graft, femoral-femoral bypass graft, questionable history of chronic kidney disease (CKD), abdominal hernia repair, alcoholic pancreatitis, chronic abdominal pain on opioids, and tobacco abuse who presented with acute on chronic abdominal pain with an unexplained rise of creatinine and anuria. The patient was found to have complete occlusion of AAA graft and was determined to have ischemic nephropathy (IN).
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Affiliation(s)
- Kevin Dao
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Pooja Patel
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Erin Pollock
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Andrew Mangano
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Kiranpreet Gosal
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
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19
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[Treatment of renal artery stenosis in the year 2021]. Internist (Berl) 2021; 62:252-262. [PMID: 33459806 DOI: 10.1007/s00108-020-00935-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
Severe arteriosclerotic stenosis of the renal artery with at least 60-70% narrowing of the lumen can lead to various diseases: in the case of unilateral stenosis it can lead to renovascular hypertension, in the case of bilateral narrowing (or in a stenotic solitary kidney) also to an often progressive renal insufficiency (ischemic kidney disease) and/or to acute pulmonary edema (pulmonary flash edema). Renal artery stenosis may be treated by revascularization using either percutaneous (balloon angioplasty with or without stenting) or less commonly open surgical procedures, both with excellent primary patency rates of over 90%; however, randomized trials of catheter-based interventions have failed to demonstrate a longer term benefit with respect to blood pressure control and renal function as well as improved overall survival over optimal medicinal management alone. Due to improved clinical outcomes interventional revascularization is justified in cases with critical stenoses and clinical sequelae, such as pulmonary flash edema and progressive renal failure. Careful patient selection is essential to maximize a potential clinical benefit.
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20
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Meng X, Yang YK, Li YH, Fan P, Zhang Y, Yang KQ, Wu HY, Jiang XJ, Cai J, Zhou XL. Clinical characteristics of concurrent primary aldosteronism and renal artery stenosis: A retrospective case-control study. Clin Exp Hypertens 2021; 43:7-12. [PMID: 32635757 DOI: 10.1080/10641963.2020.1790586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Rare cases of concurrent primary aldosteronism (PA) and renal artery stenosis (RAS) have been reported. Methods: In this retrospective case-control study, we selected a cohort of 10 PA with RAS patients and a control group of 20 PA without RAS patients from January 1, 2006, to January 1, 2016. Results: All patients presented with refractory hypertension, and a nonstatistically significant trend toward lower mean serum potassium was seen in the PA with RAS group (p =.07). PA with RAS patients had lower mean orthostatic aldosterone-to-renin ratios (38.4 ± 41.4 ng dL-1/ng mL-1 h-1 vs. 87.4.4 ± 38.4 ng dL-1/ng mL-1 h-1, respectively; p < .01) and a higher false-negative rate (50% vs. 15%, respectively; p < .05) compared with controls. All misdiagnosed patients had the diagnosis of PA confirmed when we revaluated the repeated screening and confirmative tests because of residual hypertension or hypokalemia after successful revascularization of renal artery stenosis. Conclusions: PA is easily missed in patients with RAS because of the high false-negative rate for screening tests. RAS patients with residual hypertension after successful renal angioplasty should be monitored for coexisting PA. Reevaluation of screening and confirmatory tests is helpful in establishing the correct diagnoses.
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Affiliation(s)
- Xu Meng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Yan-Kun Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Yue-Hua Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Peng Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Ying Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Kun-Qi Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Hai-Ying Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Xiong-Jing Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Jun Cai
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
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21
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Affiliation(s)
- Gates B Colbert
- Baylor University Medical Center at Dallas, 3417 Gaston Ave, Suite 875, Dallas, TX 75246, USA.
| | - Graham Abra
- Stanford University, Palo Alto, CA, USA; Satellite Healthcare, San Jose, CA, USA
| | - Edgar V Lerma
- UIC/ Advocate Christ Medical Center, Oak Lawn, IL USA
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22
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Kidney enlargement effect of angioplasty for nonatherosclerotic renovascular disease: reversibility of ischemic kidney. Hypertens Res 2020; 43:1214-1221. [PMID: 32444857 DOI: 10.1038/s41440-020-0473-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 11/08/2022]
Abstract
Renal artery stenosis causes kidney ischemia, reducing the size of the affected kidney, which eventually results in atrophy. Although renal atrophy is considered irreversible, resolution of the ischemia occasionally restores kidney size when the cause is renal artery stenosis. Angioplasty is effective in patients with nonatherosclerotic renovascular diseases (non-ARVDs). Nevertheless, renal enlargement after angioplasty has not been fully examined. We conducted a retrospective study to examine this phenomenon in non-ARVD patients. Ten patients with a <100-mm pole-to-pole length of the poststenotic kidney were treated with angioplasty. Data were collected up to 12 months after angioplasty. The mean age was 28 years; the estimated glomerular filtration rate was 92 ± 7 mL/min/1.73 m2 (mean ± SEM); blood pressure was 150/99 mmHg; 80% were women; and fibromuscular dysplasia was present in 90% of the patients. All patients had hypertension. The lengths of the poststenotic and contralateral kidney before angioplasty were 91 ± 1 and 111 ± 3 mm, respectively. After angioplasty, the length of the poststenotic kidney gradually increased during the 3 months after treatment (+5.4 mm) and that of the contralateral kidney decreased over the same time course (-3.7 mm). Enlargement was also found in the moderate atrophy subgroup (length < 92 mm), and it was greater in the <30 years old group. In a noteworthy case, renal size in the poststenotic kidney recovered from 87 to 102 mm after angioplasty. Our findings demonstrated that reduced renal size can be reversed after optimal angioplasty in non-ARVD patients, especially young patients, suggesting reversibility of the ischemic kidney.
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23
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Bhattad PB, Jain V. Renal Artery Stenosis As Etiology of Recurrent Flash Pulmonary Edema and Role of Imaging in Timely Diagnosis and Management. Cureus 2020; 12:e7609. [PMID: 32399343 PMCID: PMC7213650 DOI: 10.7759/cureus.7609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Renal hypoperfusion from renal artery stenosis (RAS) activates the renin-angiotensin system, which in turn causes volume overload and hypertension. Atherosclerosis and fibromuscular dysplasia are the most common causes of renal artery stenosis. Recurrent flash pulmonary edema, also known as Pickering syndrome, is commonly associated with bilateral renal artery stenosis. There should be a high index of clinical suspicion for renal artery stenosis in the setting of recurrent flash pulmonary edema and severe hypertension in patients with atherosclerotic disease. Duplex ultrasonography is commonly recommended as the best initial test for the detection of renal artery stenosis. Computed tomography (CT) angiography (CTA) or magnetic resonance (MR) angiography (MRA) are useful diagnostic imaging studies for the detection of renal artery stenosis in patients where duplex ultrasonography is difficult. If duplex ultrasound, CTA, and MRA are indeterminate or pose a risk of significant renal impairment, renal angiography is useful for a definitive diagnosis of RAS. The focus of medical management for RAS relies on controlling renovascular hypertension and aggressive lifestyle modification with control of atherosclerotic disease risk factors. The restoration of renal artery patency by revascularization in the setting of RAS due to atherosclerosis may help in the management of hypertension and minimize renal dysfunction.
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Affiliation(s)
| | - Vinay Jain
- Radiology, James H. Quillen Veterans Affairs Medical Center, Johnson City, USA
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24
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Abstract
This article is a comprehensive document on the diagnosis and management of fibromuscular dysplasia (FMD) which was commissioned by the Working Group 'Hypertension and the Kidney' of the European Society of Hypertension (ESH) and the Society for Vascular Medicine (SVM). This document updates previous consensus documents/scientific statements on FMD published in 2014 with full harmonization of the position of European and US experts. In addition to practical consensus-based clinical recommendations, including a consensus protocol for catheter-based angiography and percutaneous angioplasty for renal FMD, the document also includes the first analysis of the European/International FMD Registry and provides updated data from the US Registry for FMD. Finally, it provides insights on ongoing research programs and proposes future research directions for understanding this multifaceted arterial disease.
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25
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Vipparla N, Kichloo A, Albosta MS, Aljadah M, Wani F, Lone N. Resistant Hypertension Secondary to Severe Renal Artery Stenosis With Negative Duplex Ultrasound: A Brief Review of Different Diagnostic Modalities. J Investig Med High Impact Case Rep 2020; 8:2324709620914793. [PMID: 32202154 PMCID: PMC7092649 DOI: 10.1177/2324709620914793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Renal artery stenosis is a cause of resistant hypertension, which can present with several features such as severe hypertension, deterioration of renal function (with or without associated angiotensin-converting inhibitor or angiotensin receptor blocker therapy), and flash pulmonary edema. When evaluating for the presence of renal artery stenosis, the most widely utilized imaging modalities are duplex ultrasonography and computed tomography angiography. In this article, we discuss the case of a 77-year-old female who presented with shortness of breath and mild pulmonary edema, secondary to hypertensive emergency. Later, she was diagnosed with renal artery stenosis and underwent stent placement in the left renal artery. Our case highlights the different diagnostic modalities and emphasizes that the most commonly used screening, which is duplex ultrasonography, was performed on our patient but gave a false-negative result, despite high-grade stenosis, which was later diagnosed on computed tomography angiography.
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Affiliation(s)
| | - Asim Kichloo
- St. Mary's of Saginaw Hospital, Saginaw, MI, USA.,Central Michigan University, Saginaw, MI, USA
| | | | | | - Farah Wani
- St. Mary's of Saginaw Hospital, Saginaw, MI, USA
| | - Nazir Lone
- Bassett Medical Center, Cooperstown, NY, USA
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Boutari C, Georgianou E, Sachinidis A, Katsimardou A, Christou K, Piperidou A, Karagiannis A. Renovascular Hypertension: Novel Insights. Curr Hypertens Rev 2020; 16:24-29. [DOI: 10.2174/1573402115666190416153321] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 11/22/2022]
Abstract
Renovascular hypertension (RVH) remains among the most prevalent and important, but
also potentially reversible, causes of secondary hypertension. The predominant causes of renal artery
stenosis (RAS) are atherosclerotic renovascular arterial stenosis (ARAS) and renal fibromuscular
dysplasia. This condition can lead to progressive renal injury, cardiovascular complications and
‘flash pulmonary edema’. Duplex Doppler ultrasonography, computed tomographic angiography
and magnetic resonance angiography are the most commonly used diagnostic methods. There are
three therapeutic options available: medical therapy including renin-angiotensin-aldosterone system
antagonists, lipid-lowering agents, and antiplatelet therapy, percutaneous angioplasty with or without
stent placement and surgical revascularization. Three large trials failed to demonstrate the superiority
of renal artery revascularization over pharmaceutical therapy in controlling blood pressure
and preserving renal function. For this reason, today revascularization is only recommended for
patients with progressive worsening of renal function, recurrent ‘flash pulmonary edema’ and rapid
increase in antihypertensive requirement in patients with previously well-controlled hypertension.
However, more properly designed trials are needed in order to identify which patient populations
would probably benefit from renal revascularization.
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Affiliation(s)
- Chrysoula Boutari
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
| | - Eleni Georgianou
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
| | - Alexandros Sachinidis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
| | - Alexandra Katsimardou
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
| | - Konstantinos Christou
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
| | - Alexia Piperidou
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece
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Abstract
Hypertension is still the number one global killer. No matter what causes are, lowering blood pressure can significantly reduce cardiovascular complications, cardiovascular death, and total death. Unfortunately, some hypertensive individuals simply do not know having hypertension. Some knew it but either not being treated or treated but blood pressure does not achieve goal. The reasons for inadequate control of blood pressure are many. One important reason is that we are not very familiar with antihypertensive agents and less attention has been paid to comorbidities, complications as well as the hypertension-modified target organ damage in patients with hypertension. The right antihypertensive drug was not given to the right hypertensive patients at right time. This reviewer studied comprehensively the literature, hopefully that the review will help improve antihypertensive drug selection and antihypertensive therapy.
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Affiliation(s)
- Rutai Hui
- Chinese Academy of Medical Sciences FUWAI Hospital Hypertension Division, 167 Beilishilu West City District, 100037, Beijing People's Republic of China, China.
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Bardelli M, Cavressi M, Furlanis G. Valvular and/or Non-valvular Aortic Pathology Can Bias the Ultrasonographic Diagnosis of Renal Artery Stenosis. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2942-2949. [PMID: 31439362 DOI: 10.1016/j.ultrasmedbio.2019.07.414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
Renal artery stenosis (RAS) has been shown to cause a reduction in the index of maximal systolic acceleration (AImax: the maximal acceleration of flow waveform in early systole divided by the peak systolic velocity) of blood in the renal interlobar arteries, caused by local dampening of the pulse wave. In previous studies, AImax demonstrated diagnostic accuracy in terms of negative predictive value, which is useful for screening, but had a relatively low specificity. We hypothesized that an upstream focal resistance, such as an aortic stenosis or aneurysm, could act in the same way as RAS, thus generating false positives in non-stenotic kidneys. We studied 226 patients who underwent a complete protocol for RAS screening. AImax was 6.2 ± 2.9 s-1 and 13.4 ± 3.5 s-1 (mean ± standard deviation) in stenotic and non-stenotic kidneys, respectively. Diagnostic accuracy of ultrasonography with respect to the benchmark of renal computed tomography or magnetic resonance angiography (significant RAS cutoff ≥50%) resulted in 97% sensitivity, 94% specificity and a negative and positive predictive value of 99% and 55%, respectively. Using logistic regression for unexpectedly low AImax in non-stenotic kidneys (AImax cutoff ≤ 9.0 s-1), aortic pathology, such as aortic valve stenosis or aortic arch dilation (as assessed by echocardiography), was found to be the only significant predictor (Χ2 = 33.8, p < 0.0001) of false positive cases compared with clinical and hemodynamic variables. We concluded that the aortic valvular and non-valvular pathology can act as a proximal resistance that can attenuate the Doppler flowmetric parameters, which explore the flow waveform in the renal parenchymal arterial circulation, thus mimicking the presence of a focal resistance in the peripheral vascular region explored.
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Affiliation(s)
- Moreno Bardelli
- Department of Medical Sciences, University of Trieste, Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Hospital, Trieste, Italy.
| | - Monica Cavressi
- Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Hospital, Trieste, Italy
| | - Giulia Furlanis
- Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Hospital, Trieste, Italy
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Mehta OH, Cameron JD, Mirzaee S. Familial Hypercholesterolemia With Coexisting Renovascular Stenosis and Premature Coronary Artery Disease. Am J Hypertens 2019; 32:730-733. [PMID: 30868157 DOI: 10.1093/ajh/hpz037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/17/2019] [Accepted: 03/06/2019] [Indexed: 11/12/2022] Open
Abstract
Familial hypercholesterolemia (FH) is a common hereditary lipid disorder associated with substantial risk of premature atherosclerotic cardiovascular disease. We report an interesting newly diagnosed index case of FH in a 31-year-old man who presented to the hospital with an ST-elevated myocardial infarction. He had a background of inadequately treated hypertension and hypercholesterolemia. Further investigations raised the possibility of secondary hypertension after the identification of renal artery stenosis, in addition to other areas of mesenteric arterial stenoses. Our patient's case highlights that early-onset hypertension and hypercholesterolemia in a young individual may be an early manifestation of FH requiring high clinical vigilance and awareness.
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Affiliation(s)
- Ojas H Mehta
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
| | - Sam Mirzaee
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, Monash University, Melbourne, Australia
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30
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Santos SND, Alcantara MLD, Freire CMV, Cantisano AL, Teodoro JAR, Porto CLL, Amaral SID, Veloso O, Albricker ACL, Petisco ACGP, Barros FS, Barros MVL, Saleh MH, Vieira MLC. Vascular Ultrasound Statement from the Department of Cardiovascular Imaging of the Brazilian Society of Cardiology - 2019. Arq Bras Cardiol 2019; 112:809-849. [PMID: 31314836 PMCID: PMC6636370 DOI: 10.5935/abc.20190106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Monica Luiza de Alcantara
- Americas Medical City, Rio de Janeiro, RJ - Brazil.,Hospital Samaritano, Rio de Janeiro, RJ - Brazil
| | | | | | | | | | - Salomon Israel do Amaral
- Americas Medical City, Rio de Janeiro, RJ - Brazil.,Hospital Samaritano, Rio de Janeiro, RJ - Brazil
| | | | | | | | | | | | | | - Marcelo Luiz Campos Vieira
- Universidade de São Paulo (USP), São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil.,Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, SP - Brazil
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31
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Vijayvergiya R, Kanabar K, Krishnappa D, Kasinadhuni G, Sharma A, Akasaka T. Optical coherence tomography in varying aetiologies of renal artery stenosis: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5488584. [PMID: 31449625 PMCID: PMC6601173 DOI: 10.1093/ehjcr/ytz068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/21/2019] [Accepted: 04/18/2019] [Indexed: 11/24/2022]
Abstract
Background Renal artery stenosis (RAS) is a common cause of secondary hypertension. The most common aetiology is atherosclerosis; however, other causes like fibromuscular dysplasia (FMD) and Takayasu arteritis (TA) are also frequently encountered. The lesion characteristics and its response to percutaneous intervention depend upon the aetiology of RAS. Optical coherence tomography (OCT) is an excellent imaging modality to analyse coronary lesions during percutaneous coronary interventions. The data regarding the utility of OCT in renal artery imaging is limited, consisting of a few case reports. Case summary We hereby report four cases of RAS, each of different aetiology (atherosclerotic, FMD, post-transplant, and TA), who underwent OCT imaging of the renal artery along with percutaneous renal angioplasty. Discussion The advantages of OCT imaging include demonstration of the arterial wall, pathological features of the disease, and to guide percutaneous interventions. The major limitation of OCT is its lower imaging depth, which may render imaging of large vessels difficult.
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Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kewal Kanabar
- Department of Cardiology, Advanced Cardiac Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Darshan Krishnappa
- Department of Cardiology, Advanced Cardiac Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Advanced Cardiac Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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32
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Gornik HL, Persu A, Adlam D, Aparicio LS, Azizi M, Boulanger M, Bruno RM, de Leeuw P, Fendrikova-Mahlay N, Froehlich J, Ganesh SK, Gray BH, Jamison C, Januszewicz A, Jeunemaitre X, Kadian-Dodov D, Kim ESH, Kovacic JC, Mace P, Morganti A, Sharma A, Southerland AM, Touzé E, van der Niepen P, Wang J, Weinberg I, Wilson S, Olin JW, Plouin PF. First International Consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med 2019; 24:164-189. [DOI: 10.1177/1358863x18821816] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This article is a comprehensive document on the diagnosis and management of fibromuscular dysplasia (FMD), which was commissioned by the working group ‘Hypertension and the Kidney’ of the European Society of Hypertension (ESH) and the Society for Vascular Medicine (SVM). This document updates previous consensus documents/scientific statements on FMD published in 2014 with full harmonization of the position of European and US experts. In addition to practical consensus-based clinical recommendations, including a consensus protocol for catheter-based angiography and percutaneous angioplasty for renal FMD, the document also includes the first analysis of the European/International FMD Registry and provides updated data from the US Registry for FMD. Finally, it provides insights on ongoing research programs and proposes future research directions for understanding this multifaceted arterial disease.
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Affiliation(s)
- Heather L Gornik
- Division of Cardiovascular Medicine, University Hospitals Cleveland Medical Center and UH Harrington Heart and Vascular Institute, Cleveland, OH, USA
| | - Alexandre Persu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - David Adlam
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Lucas S Aparicio
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Michel Azizi
- Paris Descartes University, Paris, France
- Assistance-Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France
- Institut national de la santé et de la recherche médicale, Centre d’Investigation Clinique 1418, Paris, France
| | - Marion Boulanger
- Normandie Université, UNICAEN, Inserm U1237, CHU Caen Normandie, Caen, France
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy
| | - Peter de Leeuw
- Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Natalia Fendrikova-Mahlay
- Department of Cardiovascular Medicine, Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - James Froehlich
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Santhi K Ganesh
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Bruce H Gray
- University of South Carolina School of Medicine/Greenville, Greenville, SC, USA
| | - Cathlin Jamison
- Association belge de patients atteints de Dysplasie Fibromusculaire/FMD Groep België (FMD-Be), Brussels, Belgium
| | | | - Xavier Jeunemaitre
- APHP, Department of Genetics and Centre for Rare Vascular Diseases, Hôpital Européen Georges Pompidou, Paris, France
- INSERM, U970 – PARCC, University Paris Descartes, Sorbonne Paris
Cité, Paris, France
| | - Daniella Kadian-Dodov
- Zena and Michael A Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Esther SH Kim
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason C Kovacic
- Zena and Michael A Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pamela Mace
- Fibromuscular Dysplasia Society of America (FMDSA), North Olmsted, OH, USA
| | - Alberto Morganti
- Centro Fisiologia Clinica e Ipertensione, Policlinico Hospital, University of Milan, Milan, Italy
| | - Aditya Sharma
- Department of Medicine, Cardiovascular Medicine Division, University of Virginia, Charlottesville, VA, USA
| | | | - Emmanuel Touzé
- Normandie Université, UNICAEN, Inserm U1237, CHU Caen Normandie, Caen, France
| | - Patricia van der Niepen
- Department of Nephrology & Hypertension Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jiguang Wang
- Shanghai Institute of Hypertension and Center for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ido Weinberg
- Vascular Medicine Section and Vascular Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Scott Wilson
- Monash University (Central Clinical School of Medicine), Melbourne, VIC, Australia
- Department of Renal Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Jeffrey W Olin
- Zena and Michael A Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pierre-Francois Plouin
- Paris Descartes University, Paris, France
- Assistance-Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France
- Institut national de la santé et de la recherche médicale, Centre d’Investigation Clinique 1418, Paris, France
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Yamuna J, Chandrasekharan A, Rangasami R, Ramalakshmi S, Joseph S. Unenhanced renal magnetic resonance angiography in patients with chronic kidney disease & suspected renovascular hypertension: Can it affect patient management? Indian J Med Res 2018; 146:S22-S29. [PMID: 29578191 PMCID: PMC5890592 DOI: 10.4103/ijmr.ijmr_1613_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background & objectives: Renal artery stenosis (RAS) is an important cause of severe hypertension in patients with chronic kidney disease (CKD). It is important to detect RAS early as it can reverse hypertension and stop rapid deterioration of renal function. The potential drawbacks of various imaging modalities used to detect RAS including contrast-related adverse effects associated with diagnostic angiography have led to increasing interest in unenhanced magnetic resonance (MR) renal angiography. The aim of this study was to detect and grade RAS in patients with CKD and suspected renovascular hypertension using unenhanced MR angiography (UMRA) and to identify patients with significant RAS (>70%) who would subsequently require further investigation and revascularization. Methods: Thirty five CKD patients with suspected RAS were subjected to UMRA using non-contrast MR angiography of ArTery and VEins 3D True fast imaging with steady state precession technique over a three year period. Patients with RAS >70 per cent on UMRA were subjected to digital subtraction angiography (DSA) with intervention if indicated. Results: In all, 76 renal arteries were evaluated using UMRA in 35 patients, of which 18 arteries showed stenosis and 11 were haemodynamically significant (eight patients). Seven patients (10 renal arteries) underwent DSA. Interpretation & conclusions: An association between UMRA and DSA findings was obtained in six patients (nine renal arteries), and these patients were stented. Post-procedure follow up showed good improvement in blood pressure and renal function. UMRA was found to be a useful non-invasive imaging modality to detect RAS in CKD patients. It can identify patients who require further invasive angiography and revascularization.
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Affiliation(s)
- J Yamuna
- Department of Radiology & Imaging Sciences, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, India
| | - Anupama Chandrasekharan
- Department of Radiology & Imaging Sciences, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, India
| | - Rajeswaran Rangasami
- Department of Radiology & Imaging Sciences, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, India
| | - S Ramalakshmi
- Department of Nephrology, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, India
| | - Santhosh Joseph
- Department of Neuroradiology, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Chennai, India
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Jones H, Santamaria N. Physiological benefits to parents from undertaking skin-to-skin contact with their neonate, in a neonatal intensive special care unit. Scand J Caring Sci 2017; 32:1012-1017. [PMID: 29131378 DOI: 10.1111/scs.12543] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/18/2017] [Indexed: 11/28/2022]
Abstract
There has been increased focus on the use of family-centred care interventions, such as skin-to-skin contact (SSC) in Neonatal Intensive Special Care (NISC) Units over the past two decades. SSC between a parent and their neonate has previously shown to promote positive mental and emotional health in parents and assist in bonding and attachment between parent and neonate. The purpose of this study was to investigate the effect that SSC between parent and their neonate has on the parent's heart rate (HR) and blood pressure (BP). There has been a lack of prior research investigating the physiological responses from SSC on parents, hence the need to conduct this study. The study was conducted as an observational cohort study at The Royal Women's Hospital NISC Unit in Melbourne, Australia. One SSC between parent and neonate was recorded, and three repeated measures analysis of variance (anova) were conducted to investigate the relationship between SSC and the parent's HR, systolic BP and diastolic BP. The study found statistically significant differences between the parent's initial HR and BP, to measurements taken during the SSC (p < 0.05). This may suggest that parents' find SSC with their neonate to be a stress-reducing intervention, whilst they are in a NISC Unit. This may in turn promote associated benefits, such as a decrease in parental depression and anxiety, whilst they are in the NISC Unit, physical health benefits, as well as increased feelings of bonding between parent and their neonate. Based on the findings, it is suggested that SSC should be promoted in NISC Units as a family-centred care intervention that lowers parent's HR and BP and may provide associated health benefits.
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Affiliation(s)
- Hannah Jones
- University of Melbourne, Melbourne, Vic., Australia.,Newborn Intensive Care, The Royal Women's Hospital, Parkville, Vic., Australia
| | - Nick Santamaria
- Nursing Research, Translational Research, University of Melbourne, Melbourne, Vic, Australia
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35
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Re-evaluating the Appropriateness of Non-invasive Arterial Vascular Imaging and Diagnostic Modalities. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:63. [DOI: 10.1007/s11936-017-0558-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Morisawa N, Sugano N, Yamakawa T, Kuriyama S, Yokoo T. Successful long-term effects of direct renin inhibitor aliskiren in a patient with atherosclerotic renovascular hypertension. CEN Case Rep 2017; 6:66-73. [DOI: 10.1007/s13730-016-0246-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/24/2016] [Indexed: 11/24/2022] Open
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37
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Bishal K, Malla R, Adhikari CM, Rauniyar B, Limbu D. Fibromuscular dysplasia in an adult male as a cause of renal artery stenosis and secondary hypertension treated with renal artery stenting. Egypt Heart J 2017; 69:81-84. [PMID: 29622959 PMCID: PMC5839349 DOI: 10.1016/j.ehj.2016.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 09/17/2016] [Accepted: 09/24/2016] [Indexed: 11/24/2022] Open
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38
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Effect of Renal Artery Stenting on Blood Pressure, Glomerular Filtration Rate and Left Ventricular Mass in Hypertensive Patients with Severe Atherosclerotic Renal Artery Stenosis. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2017. [DOI: 10.5812/rijm.43288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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39
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Dehghani Dashtabi M, Falsoleiman H, Dehghani E, Fazlinezhad A, Mojahedi MJ, Shakeri MT. Effect of Renal Artery Stenting on Blood Pressure, Glomerular Filtration Rate and Left Ventricular Mass in Hypertensive Patients with Severe Atherosclerotic Renal Artery Stenosis. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2017. [DOI: 10.17795/rijm43288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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40
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Hypertension: The role of biochemistry in the diagnosis and management. Clin Chim Acta 2016; 465:131-143. [PMID: 28007614 DOI: 10.1016/j.cca.2016.12.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/11/2016] [Accepted: 12/14/2016] [Indexed: 01/10/2023]
Abstract
Hypertension is defined as a persistently elevated blood pressure ≥140/90mmHg. It is an important treatable risk factor for cardiovascular disease, with a high prevalence in the general population. The most common cause, essential hypertension, is a widespread disease - however, secondary hypertension is under investigated and under diagnosed. Collectively, hypertension is referred to as a "silent killer" - frequently it displays no overt symptomatology. It is a leading risk factor for death and disability globally, with >40% of persons aged over 25 having hypertension. A vast spectrum of conditions result in hypertension spanning essential through resistant, to patients with an overt endocrine cause. A significant number of patients with hypertension have multiple cardiovascular risk factors at the time of presentation. Both routine and specialised biochemical investigations are paramount for the evaluation of these patients and their subsequent management. Biochemical testing serves to identify those hypertensive individuals who are at higher risk on the basis of evidence of dysglycaemia, dyslipidaemia, renal impairment, or target organ damage and to exclude identifiable causes of hypertension. The main target of biochemical testing is the identification of patients with a specific and treatable aetiology of hypertension. Information gleaned from biochemical investigation is used to risk stratify patients and tailor the type and intensity of subsequent management and treatment. We review the approach to the biochemical investigation of patients presenting with hypertension and propose a diagnostic algorithm for work-up.
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41
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Yu MS, Xiang K, Haller ST, Cooper CJ. Renal Artery Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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42
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Renal Artery Stenosis After Abdominal Aortic Aneurysm Interventional Treatment in a Patient With Systemic Atherosclerosis. Am J Ther 2016; 23:e1922-e1924. [PMID: 27831942 DOI: 10.1097/mjt.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Abstract
Renal artery stenosis is a potentially reversible cause of hypertension, and transcatheter techniques are essential to its treatment. Angioplasty remains a first-line treatment for stenosis secondary to fibromuscular dysplasia. Renal artery stenting is commonly used in atherosclerotic renal artery stenosis, although recent trials have cast doubts upon its efficacy. Renal denervation is a promising procedure for the treatment of resistant hypertension, and in the future, its indications may expand.
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Affiliation(s)
- Aaron Smith
- Department of Radiology, Section of Interventional Radiology, University of California, San Diego, CA
| | - Ron C Gaba
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital & Health Sciences System, Chicago, IL
| | - James T Bui
- Department of Radiology, Division of Interventional Radiology, University of Illinois Hospital & Health Sciences System, Chicago, IL
| | - Jeet Minocha
- Department of Radiology, Section of Interventional Radiology, University of California, San Diego, CA.
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Brouwers JJ, van Wissen RC, Veger HT, Rotmans JI, Mertens B, Visser MJ. The use of intrarenal Doppler ultrasonography as predictor for positive outcome after renal artery revascularization. Vascular 2016; 25:63-73. [PMID: 27118604 DOI: 10.1177/1708538116644871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Whether patients with renal artery stenosis should undergo therapeutic revascularization is controversial. In this retrospective study, we evaluated prognostic intrarenal Doppler ultrasound parameters that might have a predictive value for a beneficial response after renal revascularization. From January 2003 until December 2012, all renovascular interventions for renal artery stenosis were analyzed. The resistive index and the maximal systolic acceleration were determined by Doppler ultrasonography prior to intervention. Thirty-two patients who underwent a renal revascularization procedure were included: 13 combined positive responders and 19 combined non-responders. The combined positive responders had a significant lower resistive index than the combined non-responders (0.5 vs. 0.6, P = 0.001) and a significant lower maximal systolic acceleration (1.0 vs. 3.8, P = 0.001) before revascularization. A prediction model (RI ≤ 0.5 and ACCmax ≤ 1.3 m/s2) was formulated to identify a subgroup that benefits from renal revascularization. This model has an expected sensitivity of 69% and specificity of 89% for improvement in renal function and/or blood pressure after revascularization. The non-invasive intrarenal Doppler ultrasound parameters resistive index and maximal systolic acceleration can be used as tools to predict improvement in renal function and/or blood pressure after revascularization of renal artery stenosis. The clinical value of this prediction model should be evaluated in a prospective trial.
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Affiliation(s)
- Jeroen Jwm Brouwers
- 1 Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Rob C van Wissen
- 1 Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Hugo Tc Veger
- 2 Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Joris I Rotmans
- 3 Department of Nephrology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Bart Mertens
- 4 Department of Medical Statistics and Bioinformatics, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Michel Jt Visser
- 1 Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
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Sag AA, Inal I, Okcuoglu J, Rossignol P, Ortiz A, Afsar B, Sos TA, Kanbay M. Atherosclerotic renal artery stenosis in the post-CORAL era part 1: the renal penumbra concept and next-generation functional diagnostic imaging. ACTA ACUST UNITED AC 2016; 10:360-7. [DOI: 10.1016/j.jash.2016.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 02/10/2016] [Accepted: 02/16/2016] [Indexed: 01/17/2023]
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46
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Sun D, Eirin A, Ebrahimi B, Textor SC, Lerman A, Lerman LO. Early atherosclerosis aggravates renal microvascular loss and fibrosis in swine renal artery stenosis. ACTA ACUST UNITED AC 2016; 10:325-35. [PMID: 26879682 DOI: 10.1016/j.jash.2016.01.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 01/04/2023]
Abstract
Renal function in patients with atherosclerosis and renal artery stenosis (ARAS) deteriorates more frequently than in nonatherosclerotic RAS. We hypothesized that ARAS aggravates stenotic-kidney micro vascular loss compared to RAS. Domestic pigs were randomized to normal, RAS, and ARAS (RAS fed a high-cholesterol diet) groups (n = 7 each). Ten weeks later stenotic-kidney oxygenation, renal blood flow, and glomerular filtration rate (GFR) were evaluated in vivo, and micro vascular density by micro-computed tomography. Blood pressure in both RAS and ARAS was elevated; and stenotic-kidney renal blood flow and GFR similarly decreased. RAS decreased the density of small-size cortical microvessels (<200 μm), whereas ARAS extended the decrease to medium-sized microvessels (200-300 μm). Cortical hypoxia and interstitial fibrosis increased in both RAS and ARAS but correlated inversely with micro vascular density only in RAS. Atherosclerosis aggravates loss of stenotic-kidney microvessels, yet additional determinants likely contribute to cortical hypoxia and fibrosis in swine ARAS.
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Affiliation(s)
- Dong Sun
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Department of Nephrology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Alfonso Eirin
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Behzad Ebrahimi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephen C Textor
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA.
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47
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Kurata Y, Kido A, Fujimoto K, Kiguchi K, Takakura K, Moribata Y, Shitano F, Himoto Y, Fushimi Y, Okada T, Togashi K. Optimization of non-contrast-enhanced MR angiography of the renal artery with three-dimensional balanced steady-state free-precession and time-spatial labeling inversion pulse (time-SLIP) at 3T MRI, in relation to age and blood velocity. Abdom Radiol (NY) 2016; 41:119-26. [PMID: 26830618 DOI: 10.1007/s00261-015-0608-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the optimal inversion time (TI) value of three-dimensional (3D) balanced steady-state free-precession time-spatial labeling inversion pulse (time-SLIP) technique for visualization of the renal artery at 3T MRI, and to assess whether the optimal TI is affected by the subject's age and blood velocity. MATERIALS AND METHODS Forty-two healthy volunteers (range 20-67 years) were enrolled in the study and subjected to non-contrast-enhanced renal MR angiography. Five different TI values (1200, 1400, 1600, 1800, and 2000 ms) were selected for evaluation. For quantitative evaluation, the relative signal intensity (SI) of the main renal artery was compared with that of the renal medulla (Vessel-to-Kidney ratio; VKR). Blood velocity of the abdominal aorta was measured using 2D phase contrast technique. For qualitative evaluation, two radiologists scored the depiction of the renal pelvis and the quality of visualization of the renal artery. RESULTS VKR is the highest at TI = 1600 ms. A strong negative correlation between age and blood velocity was demonstrated. Regarding the qualitative evaluation, the overall image scores of renal arteries were the highest at a TI = 1800 ms for both readers. The optimal TI values in subjects below 50 years of age were 1600 and 1800 ms, whereas in subjects above 50 years of age, the optimal TI value was 1800 ms. CONCLUSION The optimal TI value for the visualization of renal arteries using time-SLIP technique at 3T MRI was 1800 ms. Subjects' age affected optimal TI and this is likely due to differences in the blood velocity of the abdominal aorta.
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Affiliation(s)
- Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan.
| | - Koji Fujimoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Kayo Kiguchi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Kyoko Takakura
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Yusaku Moribata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Fuki Shitano
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Tomohisa Okada
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
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Zhu Y, Ren J, Ma X, Chen MH, Zhou Y, Jin M, Liu Z. Percutaneous Revascularization for Atherosclerotic Renal Artery Stenosis: A Meta-Analysis of Randomized Controlled Trials. Ann Vasc Surg 2015; 29:1457-67. [DOI: 10.1016/j.avsg.2015.06.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/30/2015] [Accepted: 06/21/2015] [Indexed: 10/23/2022]
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Mishima E, Kikuchi K, Ota H, Akiyama Y, Suzuki T, Seiji K, Hashimoto J, Takase K, Abe T, Ito S. Detection of Segmental Renal Ischemia by Diffusion-Weighted Magnetic Resonance Imaging: Clinical Utility for Diagnosis of Renovascular Hypertension. J Clin Hypertens (Greenwich) 2015; 18:364-5. [DOI: 10.1111/jch.12675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eikan Mishima
- Division of Nephrology, Endocrinology, and Vascular Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Koichi Kikuchi
- Division of Nephrology, Endocrinology, and Vascular Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Hideki Ota
- Department of Diagnostic Radiology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Yasutoshi Akiyama
- Division of Nephrology, Endocrinology, and Vascular Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Takehiro Suzuki
- Division of Nephrology, Endocrinology, and Vascular Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
- Division of Medical Science; Tohoku University Graduate School of Biomedical Engineering; Sendai Japan
| | - Kazumasa Seiji
- Department of Diagnostic Radiology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Junichiro Hashimoto
- Division of Nephrology, Endocrinology, and Vascular Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Kei Takase
- Department of Diagnostic Radiology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Takaaki Abe
- Division of Nephrology, Endocrinology, and Vascular Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
- Division of Medical Science; Tohoku University Graduate School of Biomedical Engineering; Sendai Japan
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology, and Vascular Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
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50
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Mishima E, Hashimoto J, Akiyama Y, Shima H, Seiji K, Takase K, Abe T, Ito S. Impact of Small Renal Ischemia in Hypertension Development: Renovascular Hypertension Caused by Small Branch Artery Stenosis. J Clin Hypertens (Greenwich) 2015; 18:248-9. [PMID: 26293888 DOI: 10.1111/jch.12661] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eikan Mishima
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Junichiro Hashimoto
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasutoshi Akiyama
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hisato Shima
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazumasa Seiji
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaaki Abe
- Division of Medical Science, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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