Zehra Eren, M.D.
• explain hypertansion and renal disease interaction,
• describe renovascular diseases
• describe diagnostic evaluation
• explan therapy in renovascular deseases
• describe and manage renal artery and vein
thrombosis
• explain microvascular renal diseases

Asemptomatic ‘’İncidental Renal Artery Stenosis’’

Renovascular Hypertension

İschemic Nephropathy

Accelerated CV Disease
-Congestive heart failure
-Stroke
-Secondary aldosteronism

Asemptomatic ‘’İncidental Renal
Artery Stenosis (RAS)’’

Renovascular Hypertension

İschemic Nephropathy

Accelerated CV Disease
-Congestive heart failure
-Stroke
-Secondary aldosteronism

Some degree of RAS can be identified in 20%-
45% of patients undergoing vascular imaging

Most of these stenoses are of little or no
hemodynamic significance
Asemptomatic ‘’İncidental Renal Artery
Stenosis (RAS)’’
 Renovascular Hypertension



İschemic Nephropathy
Accelerated CV Disease
-Congestive heart failure
-Stroke
-Secondary aldosteronism

Reduced renal perfusion
Rise in arterial pressure

Diagnosis is established only in retrospect after
succesful reversal of HT with revascularization

3%-5%, F>M

Medial fibroplasia is the most common

Location: midportion of the vessel

Smoking is a risk factor for progression

Most common renovascular lesion
(75% - 84%)

Location: origin of artery

Associated with HT, DM, HPL, smoking,
abnormal renal function

Asemptomatic ‘’İncidental Renal Artery Stenosis’’

Renovascular Hypertension

İschemic Nephropathy

Accelerated CV Disease
-Congestive heart failure
-Stroke
-Secondary aldosteronism

Establish presence of RAS: location and type of
lesion

Establish whether unilateral or bilateral stenosis
(or stenosis to a solitary kidney)

Establish presence and function of stenotic and
nonstenotic kidneys

Establish hemodynamic severity of renal arteral
disease

Plan vascular intervention

Physiologic and functional studies of the
Renin-Angiotensin system
-plasma renin levels
-measurement of renal vein renin levels

Noninvasive imaging and assesment of the
renal vasculature
-Doppler USG
-radyonuclide imaging
-magnetic resonance arteriography
-computed tomographic angiography

Improved BP

Prevent morbidity and mortality

Preservation of renal function

Medical therapy

Surgical therapy
-angioplasty
-angioplasty and stent replacement

Hemolytic- Uremic Syndrome (HUS)

Thrombotic- Thrombocytopenic Purpura
(TTP)

Microangiopathic hemolytic anemia

Thrombocytopenic purpura

Acute renal failure

Fever

Neurologic dysfunction