During a routine medical checkup, Candace, a 26-year old physiotherapy student, is surprised to hear that her blood pressure is 180/110. She also has a rumbling systolic and diastolic abdominal bruit (murmur) that is loudest at the mid-epigastric area. Her physician suspects renal artery stenosis (narrowing). She orders an abdominal ultrasound and renal artery arteriography, which confirms that Candace has a small right kidney, and that the distal part of her right renal artery is narrowed by more than 70%. Her physician prescribes diuretics and calcium channel blockers as temporary measures, and refers Candace to a cardiovascular surgeon. Explain the connection between Candace's renal artery stenosis and her hypertension. Why is her right kidney smaller than her left? What would you expect Candace's blood levels of aldosterone, angiotensin II, and renin to be?
Solution
VerifiedRenal Artery Stenosis
- is a well known cause of 2ry Hypertension.
- and also a cause of Renal Failure.
Etiology :
1- Atherosclerosis of renal artery. 2- Fibromuscular dysplasia. 3- Rare causes include: Takayasu arteritis, Dissecting aneurysm, External artery compression by tumor or fibrosis.
clinical picture :
1- Hypertension : usually severe, of recent onset and difficult to control. 2- Bruit : an abdominal or flank bruit ( = systolic and diastolic abdominal Bruit, loudest at the mid- epigastric area ). 3- may be Hypokalemia and mild Metabolic Alkalosis. 4- Kidney Size : - kidneys are asymmetrical in size. - there is reduction in kidney size ( in affected side ) in long standing stenosis which can be detected by abdominal Ultrasound. 5- Renal impairment.
Investigations :
1- Abdominal Ultrasound : a discrepancy in size between the 2 kidneys. 2- Renal Isotope Scanning. 3- Renal Vein Renin studies. 4- Renal Angiography.
Treatment:
1- Medical Treatment : Antihypertensive drugs e,g, diuretics and calcium channel blockers. 2- Angioplasty " PTCA ". 3- Surgical resection of affected segment and reanastomosis.
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