Orthostatic hypertension due to coexistence of renal fibromuscular dysplasia and nephroptosis.

Tsukamoto, Yusuke; Komuro, Yuuichi; Akutsu, Fujio; Fujii, Kazuhumi; Marumo, Fumiaki; Kusano, Shouichi; Kikawada, Ryuichi

doi:10.1253/jcj.52.1408

Cited by 12 publications

(4 citation statements)

References 10 publications

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“…This particular condition has been observed in patients with nephroptosis, a clinical entity characterized by increased mobility of the kidneys and defined as significant descend of the kidney (by at least 5 cm or two vertebral bodies on intravenous urography) when standing . Descend of the kidney can cause stretching and torsion of the renal artery, reduction of renal blood flow and, consequently, OHT . Lastly, other, relatively rare, OHT causes that should be suspected in cases of extreme orthostatic BP increase are pheochromocytoma, mast cell activation, and norepinephrine transporter deficiency …”

Section: Pathophysiologymentioning

confidence: 99%

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Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations

Magkas

Tsioufis

Thomopoulos

et al. 2019

J of Clinical Hypertension

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Orthostatic hypertension (OHT), that is, sustained increase in blood pressure after standing, is an increasingly recognized cardiovascular disorder having been examined in much fewer studies compared with orthostatic hypotension (OH). However, in both OHT and OH, dysfunction of the autonomous nervous system is considered to be the primary pathophysiological disturbance, while significant associations with essential hypertension have been observed. Although in many studies OHT has been related to subclinical or clinical target organ damage, there is also evidence denying such an association. Because OHT is defined variably across different studies, the comparison of relevant outcomes is at least problematic. Since evidence about OHT treatment is exclusively based on limited non‐randomized studies, no specific recommendations have been developed. Therefore, both the prognostic role and the clinical significance of OHT remain largely undefined. The aim of the present review is to summarize the available evidence regarding the definition, diagnosis, pathophysiology, prognostic role and treatment of OHT and highlight potential clinical implications of this underestimated condition.

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Section: Pathophysiologymentioning

confidence: 99%

“…In OHT patients with nephroptosis, surgical correction with nephropexy has been reported to be curative, however, this procedure is not routinely used due to high rates of complications . Finally, renal revascularization could be a therapeutic option in case of concomitant significant renal artery stenosis …”

Section: Treatmentmentioning

confidence: 99%

Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations

Magkas

Tsioufis

Thomopoulos

et al. 2019

J of Clinical Hypertension

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show abstract

“…Detection of OHT associated with nephroptosis can be of considerable therapeutic value as patients could be treated with nephropexy resulting in resolution of OHT and hypertension as well. Patients with associated fibromuscular dysplasia may also be effectively treated with percutaneous renal angioplasty [36]. …”

Section: The Clinical Spectrum Of Ohtmentioning

confidence: 99%

An Emerging Role for Understanding Orthostatic Hyp‘er’tension in the Cardiorenal Syndrome

et al. 2011

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Orthostatic hypertension (OHT) is a clinically important problem increasingly recognized in persons with borderline hypertension, diabetes mellitus, and autonomic neuropathies, and in the elderly. Moreover, the association of OHT with progression of target end-organ damage, especially coronary heart disease and chronic kidney disease (CKD), and the attendant increased cardiovascular disease (CVD) and CKD risk, is gaining attention but is still underappreciated. There are various mechanisms that contribute to the development of OHT: excessive vascular adrenergic sensitivity, baroreceptor reflex abnormalities, and inappropriate activation of the renin-angiotensin-aldosterone system, which are also mechanisms that lead to cardiorenal metabolic disease (CRS). While the evidence is compelling for the clinical importance of OHT, more investigation is needed to evaluate the effects of OHT on CKD and CVD. The notion that the development of OHT is a risk factor for the development of CRS raises the need for further clinical and investigational attention to this clinical dilemma.

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“…Kidney fixation was accomplished by suturing the renal capsule to the quadratus lumborum. The sur¬ gical results were characterized by a mean operative time of 4.0 (range 2.5-7) hours, a mean parenteral narcotic requirement of 42.7 mg (range 18.5-80) of morphine sulfate, an estimated blood loss of <50 mL in all cases, a mean of 12.5 (range [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] hours to resumption of oral intake, and a mean hospital stay of 2.5 (range \-<X) days. Patients reported a return to normal ac¬ tivity at a mean of 2.5 (range l^t) weeks, and 100% were asymptomatic at a mean follow-up of 11 (range 2-30) months.…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic Nephropexy

Rehman¹,

Hoenig²

2000

Journal of Endourology

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Although there has long been debate about the existence of nephroptosis, contemporary radiologic and biochemical studies confirm its existence. Both percutaneous and laparoscopic operations are available for fixing the kidney, with high early success rates. Objective documentation of the diagnosis is mandatory. Further studies with validated quality-of-life and pain questionnaires are needed to determine the long-term success of nephropexy.

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Orthostatic hypertension due to coexistence of renal fibromuscular dysplasia and nephroptosis.

Cited by 12 publications

References 10 publications

Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations

Orthostatic hypertension: From pathophysiology to clinical applications and therapeutic considerations

An Emerging Role for Understanding Orthostatic Hyp‘er’tension in the Cardiorenal Syndrome

Laparoscopic Nephropexy

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