Renovascular Hypertension

Abstract

Renovascular disease (RVD) is a major cause of secondary hypertension. Atherosclerotic renal artery stenosis is the most common type of RVD followed by fibromuscular dysplasia. It has long been recognized as the prototype of angiotensin-dependent hypertension. However, the mechanisms underlying the physiopathology of hypertensive occlusive vascular renal disease are complex and distinction between the different etiologies of RVD should be made. In an era of neutral results of recent prospective clinical trials regarding the benefit of renal artery revascularization, recognition of these distinct types of RVD with different degrees of renal occlusive disease is important for management. Many patients with RVD will be managed medically, while others with high risk clinical presentations and potential organ failure benefit from revascularization in addition to medical therapy. The greatest challenge is to individualize and implement the best approach for each patient in the setting of widely different comorbidities.

Uric Acid and Hypertension: Prognostic Role and Guide for Treatment

“…Other than triggering RAAS, UA has been shown to induce hypertension through a crystal and pressure-independent kidney afferent arteriolopathy [ 27 , 28 , 29 ]. Afferent arteriolopathy can indeed lead to impaired renal blood flow, ischemia, and consequent renovascular hypertension [ 75 , 76 ]. However, the exact mechanism whereby UA can induce arteriolopathy remains partially unsolved.…”

Recovery of Renal Function following Kidney-Specific VEGF Therapy in Experimental Renovascular Disease

“…Body weight was similar between all groups and sexes at the 6- and 10-week time points (Tables 1, 2). The degree of renal artery stenosis, quantified by renal angiography, remained stable throughout the study at approximately 70% (Tables 1, 2), which is hemodynamically significant [30]. Prior to treatment at 6 weeks, blood pressure was significantly and similarly elevated in all pigs compared to normal.…”

“…Renovascular disease (RVD), most often caused by atherosclerotic renal artery stenosis [1], is a leading cause of secondary hypertension. It may lead to and exacerbate the progression of chronic kidney disease (CKD) [1, 2] and significantly increase cardiovascular risk [3].…”

“…Renovascular disease (RVD), most often caused by atherosclerotic renal artery stenosis [1], is a leading cause of secondary hypertension. It may lead to and exacerbate the progression of chronic kidney disease (CKD) [1, 2] and significantly increase cardiovascular risk [3]. Progressive damage and loss of the renal microvasculature is a major pathological feature in chronic renal diseases that correlates with the progression of renal injury [4, 5], irrespective of the etiology.…”

Progress toward the Clinical Application of Mesenchymal Stromal Cells and Other Disease-Modulating Regenerative Therapies: Examples from the Field of Nephrology

“…(15) Renovascular disease is a common cause for secondary hypertension in individuals aged 65 years and older and RVD attributed to atherosclerotic plaque development with reduction in renal artery dimension, represents a unique intersection between hypertension and CKD/ESRD leading to progressive renal insufficiency. (16) In the setting of significant RVD, further reduction of renal blood flow and hypoxia trigger inflammation, oxidative stress and pro-fibrotic pathways, leading to scarring and further deterioration of renal function (ischemic nephropathy). (17) Importantly, recent clinical trials and experimental studies indicate that restoration of large vessel patency alone is not enough to regain kidney function in most patients with atherosclerotic RVD.…”