Renal Hypertension
from WebMD.com
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What Is Renal Hypertension?
Renal hypertension, also called renovascular hypertension, is elevated blood pressure caused by kidney disease. It can usually be controlled by blood pressure drugs. Some people with renal hypertension can be helped by angioplasty, stenting, or surgery on the blood vessels of the kidney. Renal hypertension is caused by a narrowing in the arteries that deliver blood to the kidney. One or both kidneys' arteries may be narrowed. This is a condition called renal artery stenosis. When the kidneys receive low blood flow, they act as if the low flow is due to dehydration. So they respond by releasing hormones that stimulate the body to retain sodium and water. Blood vessels fill with additional fluid, and blood pressure goes up. |
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The narrowing in one or both renal arteries is most often caused by atherosclerosis, or hardening of the arteries. This is the same process that leads to many heart attacks and strokes. A less common cause of the narrowing is fibromuscular dysplasia. This is a condition in which the structure of the renal arteries develops abnormally for unclear reasons.
Causes of Renal Hypertension
Renal hypertension is caused by a narrowing in the arteries that deliver blood to the kidney. One or both kidneys' arteries may be narrowed. This is a condition called renal artery stenosis.
When the kidneys receive low blood flow, they act as if the low flow is due to dehydration. So they respond by releasing hormones that stimulate the body to retain sodium and water. Blood vessels fill with additional fluid, and blood pressure goes up.
Symptoms of Renal Hypertension
Renal hypertension usually causes no symptoms. The narrowing in the arteries can't be felt. Unless it's dangerously high, high blood pressure causes no symptoms either. Symptoms of severely elevated blood pressure include:
Renal hypertension can cause chronic kidney disease. This is a slow decline in kidney function. Until the condition is well advanced, chronic kidney disease also causes no symptoms.
Because there are usually no symptoms, a doctor may suspect renal hypertension when someone has uncontrolled high blood pressure despite multiple medications or has unexplained chronic kidney disease.
Treatments for Renal Hypertension
Medications are used first to try to control high blood pressure in renal hypertension. The most important blood pressure medications to treat renal hypertension include:
For most people with renal hypertension due to renal artery narrowing, medications can effectively control blood pressure. More than one blood pressure drug is often needed, however.
In some people with renal hypertension due to narrowing of the renal artery, even taking three or more medications every day may not adequately control blood pressure. In these situations, a procedure to improve blood flow to the kidneys can often help.
Possible procedures include the following.
Angioplasty. A doctor threads a catheter through a large artery in the groin and advances it into the renal artery. A balloon is then inflated for a few moments. This widens the artery and improves blood flow.
Stenting. During angioplasty, a wire-mesh stent can be expanded inside the renal artery. The stent stays in place. This keeps the artery open after the balloon is removed. In general, stenting is more effective than angioplasty at improving blood flow to the kidney.
Surgery. A surgeon can bypass the narrowed renal artery by sewing a healthy blood vessel next to it. Surgery is generally considered only when angioplasty and stenting are not possible.
These procedures are similar to those used to improve blood flow in the heart in people with coronary artery disease.
Causes of Renal Hypertension
Renal hypertension is caused by a narrowing in the arteries that deliver blood to the kidney. One or both kidneys' arteries may be narrowed. This is a condition called renal artery stenosis.
When the kidneys receive low blood flow, they act as if the low flow is due to dehydration. So they respond by releasing hormones that stimulate the body to retain sodium and water. Blood vessels fill with additional fluid, and blood pressure goes up.
Symptoms of Renal Hypertension
Renal hypertension usually causes no symptoms. The narrowing in the arteries can't be felt. Unless it's dangerously high, high blood pressure causes no symptoms either. Symptoms of severely elevated blood pressure include:
- Headache
- Confusion
- Blurry or double vision
- Bloody (pink-colored) urine
- Nosebleed
Renal hypertension can cause chronic kidney disease. This is a slow decline in kidney function. Until the condition is well advanced, chronic kidney disease also causes no symptoms.
Because there are usually no symptoms, a doctor may suspect renal hypertension when someone has uncontrolled high blood pressure despite multiple medications or has unexplained chronic kidney disease.
Treatments for Renal Hypertension
Medications are used first to try to control high blood pressure in renal hypertension. The most important blood pressure medications to treat renal hypertension include:
- ACE inhibitors (angiotensin converting enzyme inhibitors). These include lisinopril, captopril, benazepril, ramipril, and others.
- ARBs (angiotensin II receptor blockers). Examples include valsartan,losartan, candesartan, and olmesartan.
For most people with renal hypertension due to renal artery narrowing, medications can effectively control blood pressure. More than one blood pressure drug is often needed, however.
In some people with renal hypertension due to narrowing of the renal artery, even taking three or more medications every day may not adequately control blood pressure. In these situations, a procedure to improve blood flow to the kidneys can often help.
Possible procedures include the following.
Angioplasty. A doctor threads a catheter through a large artery in the groin and advances it into the renal artery. A balloon is then inflated for a few moments. This widens the artery and improves blood flow.
Stenting. During angioplasty, a wire-mesh stent can be expanded inside the renal artery. The stent stays in place. This keeps the artery open after the balloon is removed. In general, stenting is more effective than angioplasty at improving blood flow to the kidney.
Surgery. A surgeon can bypass the narrowed renal artery by sewing a healthy blood vessel next to it. Surgery is generally considered only when angioplasty and stenting are not possible.
These procedures are similar to those used to improve blood flow in the heart in people with coronary artery disease.
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Results of Treatment Blood pressure improves in many people who have a procedure or surgery for renal hypertension. After the procedure, some may be able to stop taking blood pressure medicines entirely. Surgery is generally the most effective at correcting renal hypertension. Stenting is also effective. But the procedure may need to be repeated to have a lasting result. Angioplasty is somewhat less effective than stenting or surgery. Generally, procedures are more effective when only one kidney's artery is narrowed rather than both. |