Renal artery stenosis: the challenging in diagnosis and therapy

Abstract

Hypertension is still the most prevalent non-communicable diseases in Indonesia. Renovascular hypertension is one type of secondary hypertension. It is commonly caused by the presence of renal artery stenosis (RAS). Whereas, atherosclerosis (ARAS) and fibromuscular disease (FMD) are the most common causes of RAS. Early diagnosis is necessary because it has the potential to be cured by eliminating stenosis of the renal artery. However, the signs and symptoms of renovascular hypertension are not specific. The supporting examination to diagnose RAS is also expensive. So, screening in the population at risk is needed. The examinations to prove the presence of RAS are arteriography, captopril renogram, renal ultrasonography, renal Doppler ultrasonography, magnetic resonance angiography (MRA), and computed angiographic tomography (CTA).
 Until now, three therapeutic modalities can be selected in the management of renovascular hypertension; pharmacological therapy, surgical intervention, percutaneous intervention angioplasty with and without stenting. This narrative review summarizes the literature focused on the diagnosis and therapy of RAS.

The social function of intellectual property and government intervention in mitigating the pandemic: A perspective from Indonesia

“…With these characteristics, Vaksin Merah Putih is expected to reach all regions in Indonesia and some countries where it's difficult to provide special storage places. 97 Further, with its 'halal' certification, Vaksin Merah Putih is expected to cover the entire population, including countries with Muslim population. 98 To achieve this goal, the Minister of Health emphasized that after conducting clinical trials, Vaksin Merah Putih must be immediately carried out a global-scale registration process.…”

“…113 For the need for the implementation of the COVID-19 vaccination, the Minister of Health stipulates: criteria and priorities for vaccine recipients, priority areas for vaccine recipients, schedules and stages of vaccine administration, and vaccination service standards. 114 In terms of funding for the procurement of the COVID-19 Vaccine and the Implementation of the COVID-19 Vaccination, it is sourced from the State Revenue and Expenditure Budget, 115 other legal sources in accordance with laws and regulations, and the Regional Revenue and Expenditure Budget (specifically for the implementation of the COVID-19 Vaccination). 116 The impact of COVID-19 on household finances has been severe, 117 In relation to administrative sanction, Presidential Regulation Number 14 of 2021 formulates sanctions for everyone who has been determined to be a COVID-19 vaccine recipient but does not vaccinate against COVID-19 is subject to administrative sanctions 120 in the form of: postponement or termination of the provision of social security or social assistance, postponement or termination of government administration services, and/or fines.…”

“…136 For this reason, the government must maximize policies derived from the protective articles of TRIPS to anticipate the negative impacts arising from the protection of drug patents in the public health sector, by strategically implementing TRIPs Waiver in the terms of limitations exceptions of patent protection, for example, government use and compulsory license. 137,138 In addition to the cooperative policy that is currently being carried out by the Indonesian government to ensure the availability of the COVID-19 vaccine, 139,140 the government has also prepared policies related to IPR. This policy is prepared to anticipate when pharmaceutical companies that are inventors of medicines and or vaccines for COVID-19 have succeeded in obtaining patents.…”