With a narrowing of the diameter of the renal artery, renal blood flow deteriorates significantly. A pathological phenomenon is characteristic of such an ailment as renovascular hypertension. This is a type of arterial hypertension that occurs in only 3-5% of patients suffering from high blood pressure. Symptoms of the disease depend on the causes that led to its development. Let us consider in more detail the pathogenesis, clinical picture, methods of diagnosis and treatment of this ailment.
Renovascular hypertension - what is it?
Currently, pathologies of the cardiovascular system are increasingly being diagnosed not only in the elderly, but also in the younger generation. This is due to the negative influence of various factors: hereditary predisposition, bad habits, the presence of chronic diseases. The disease can cause the development of other similar pathologies. One of such diseases is renovascular arterial hypertension.
The syndrome occurs against a background of narrowing of blood vessels in the kidneys and impaired circulation. In the absence of timely treatment, the disease can lead to tissue ischemia, renal failure. Only a small number of patients with blood pressure problems are diagnosed with a disorder. Renovascular hypertension can affect one or both kidneys.
Pathogenesis
According to studies conducted by specialists, narrowing of the renal artery causes an increased synthesis of renin, a component that regulates blood pressure and is responsible for reducing the volume of peripheral vessels. This is necessary to normalize the blood supply to the kidney. However, the narrowed lumen of the artery does not allow to establish blood flow.
Simultaneously with this process, increased activity of aldosterone and angiotensin in the blood is observed. The first substance is the hormone secreted by the adrenal glands. It is released due to angiotensin (an oleopeptide hormone) and affects only a healthy kidney, decreasing urine production due to sodium retention. This prevents the kidneys from fully performing their blood purification functions and causes the development of an ailment such as renovascular arterial hypertension.
The pathogenesis of the disease gives an idea of how the syndrome originates, and what needs to be done to restore the proper functioning of the kidneys. With complete normalization of blood circulation in the affected vessels, the patient's condition improves and the disease recedes.
Causes of the disease
Currently, doctors name several main reasons that can serve as an impetus in the development of a pathological condition. Vasorenal (renovascular) hypertension most often occurs against the background of the following diseases:
- Atherosclerosis is the main reason for the development of nephrogenic arterial hypertension. Cholesterol plaques narrow the lumen of the vessels approximately halfway at the site of entry into the kidney. The disease most often affects men aged 40-55 years. In women, the pathology usually manifests itself after 60 years.
- Fibromuscular dysplasia of the renal arteries is an inflammatory process in which the structure of the muscle tissue of the vessels changes. Hyperplasia is often found in young people, as well as in childhood. In addition to hyperplasia of muscle elements, the formation of microaneurysms is observed. The etiology of fibromuscular dysplasia is unknown.
- Takayasu disease is a syndrome associated with inflammatory processes in the aorta and the formation of a blood clot. The disease is also called heart failure disease. The narrowing of the vessels leads to a thickening of the vascular membranes against the background of destruction and swelling of the vascular tissue. The disease has an autoimmune etiology.
- Mechanical compression of blood vessels - occurs against the background of the formation of tumors, cysts and aneurysms of blood vessels. In case of impaired blood flow, renovascular hypertension develops. What is it and how to deal with this ailment will be discussed below.
Clinical picture
Symptoms of the disease have signs of hypertension and kidney pathologies. The severity of the clinical picture of the disease depends on the form of the course of renovascular hypertension and the factors that led to its development. With the rapid development of characteristic symptoms, they speak of a malignant type. If the pathology develops slowly, the disease is benign.
In most cases, severe renovascular hypertension is diagnosed. Symptoms of the disease are as follows:
- consistently high blood pressure, not decreasing even with the use of drugs;
- increased diastolic pressure against the background of normal systolic indicators;
- myocardial hypertrophy;
- increased pressure against the background of sharp pains in the lumbar region;
- noise when listening to the renal arteries.
At a young age, sharp jumps in blood pressure should be alarming. This is especially true in cases where the next of kin did not suffer from hypertension and the disease could not be inherited.
Signs of benign and malignant renovascular hypertension
With a slow development of the pathological process, there is a slight increase in the “upper” pressure and a significant increase in the “lower” pressure. For example, 130/110 or 140/110 mmHg. Art. In this case, the patient complains of a general deterioration, shortness of breath, weakness.
The appearance of symptoms such as blurred vision, severe pain in the back of the head, nausea and vomiting, increased “lower” pressure to 120 mmHg. Art. says that malignant renovascular hypertension develops. What forecast does the specialist give in this case? Extremely unfavorable, because patients rarely seek timely qualified medical help.
To correctly diagnose and prevent the development of a severe course of pathology, an examination should be performed when the first symptoms of hypertension appear.
Diagnostic Methods
During the initial treatment, the specialist will refer the patient to a laboratory test. An accurate diagnosis of only one of the symptoms and complaints of the patient is practically impossible in this case. It is necessary to take tests to determine the level of cholesterol, creatinine, renin, potassium and aldosterone in the blood. Analysis of blood serum for ACE allows you to determine stenosis of the arteries. Laboratory studies help to differentiate the disease from inflammatory processes in the kidneys.
Instrumental examination methods are mandatory in cases of suspected development of such a serious illness as renovascular hypertension. Diagnosis usually begins with an ultrasound, during which you can determine the size of the kidneys, the presence of neoplasms and cysts, and abnormal organ development.
To study the state of the vessels of the kidneys, angiography is used. The method allows to establish the degree of their narrowing due to the introduction of a contrast medium. The diagnostic method has a number of contraindications, which should first be familiarized with.
Dopplerography allows assessing the state of blood flow in the vessels of the kidneys. This is one of the methods of ultrasound. However, unlike conventional ultrasound, doppler helps to get more valuable information. It is prescribed for an unknown etiology of arterial hypertension, to assess the size of tumors and blood flow in them, with suspected renal failure.
Radionuclide urography
Renovascular hypertension is often diagnosed using radionuclide urography. The method involves the introduction into the body of a small amount of a radioactive drug. The activity of the drug is recorded by a gamma camera in front of which the patient is located.
The duration of the examination depends on the severity of the patient's condition. Usually the procedure is carried out within 1 hour. The images obtained from the examination allow us to judge the work of both kidneys and the blood flow in them.
Radioactive drugs, unlike contrast agents, are much less likely to cause the development of any side effects.
Renovascular hypertension: treatment
The treatment of this type of hypertension presents significant difficulties. The disease often manifests itself in its malignant form and is resistant to medications. With the rapid development of symptoms of the disease, abnormalities in the functioning of the liver, brain, and lungs can occur. Usually in these cases, surgery is performed.
Radical methods of treatment allow (in most cases) to prevent serious consequences. Surgery is performed only when the kidneys retain their functions. One of the methods is balloon angioplasty. During the operation, a catheter with a silicone balloon at the end is inserted into the lumen of the stenotic artery. When the narrowed section is reached, the balloon is inflated, and the balloon, in turn, opens the microprosthesis located at the end of the catheter. The technique has several advantages - low invasiveness and lack of anesthesia for surgery.
It should be borne in mind that the method described above is not suitable for diagnosing stenosis of vessels located in the mouth of the renal artery or with its complete narrowing. In this case, open surgery is indicated.
In the event that the ailment develops against the background of a tumor, cyst or hematoma, it is necessary to carry out surgery and remove the neoplasm. This will restore blood flow and organ functionality.
With a benign course of pathology, it is possible to quite successfully reduce blood pressure, eliminate pain in the kidneys using conservative therapy. Arterial hypertension, including renovascular, is treated under the strict supervision of a specialist. Only a doctor can choose a complex therapy aimed at improving the patient's condition.
At an early stage in the development of pathology, the use of the following groups of medicines is indicated:
- Angiotensin receptor blockers (reduce the risk of heart attack and stroke);
- ACE inhibitors have (cytoprotective and vasodilating effect);
- Calcium channel blockers (stabilize calcium levels).
Renovascular hypertension is also treated with diuretics and drugs that lower blood pressure. The dosage of medications depends on the severity of the patient's condition. With prolonged use of drugs, it is necessary to check the level of potassium in the blood every six months. The most pronounced therapeutic effect is exerted only by complex therapy at the maximum dosage of drugs.
Folk methods
Renovascular arterial hypertension can also be treated with alternative methods. However, it is better to use them in combination with traditional medicine. Folk recipes allow you to normalize blood pressure, cleanse blood vessels of cholesterol plaques and improve blood flow. The use of rose hips gives a good result. The plant has a powerful diuretic effect. With renal pressure, it is necessary to brew 1 tbsp. l fruits with a glass of boiling water, insist on a water bath for 15 minutes and take it like tea twice a day.
To reduce high blood pressure, an infusion of lingonberry leaves will help. Preliminarily, the leaves (2 tbsp. L.) Are crushed and 250 ml of boiling water are poured. The resulting mixture is insisted on a water bath for at least half an hour, filtered, cooled and taken in the third part of the glass 3 times a day.
In the event that renovascular hypertension was diagnosed at the initial stage of development, you can prepare an infusion of the following components:
- peppermint - 2 tbsp. l .;
- inflorescences of hawthorn - 3 tbsp. l .;
- birch leaves - 3 tbsp. l .;
- kidney tea leaves - 4 tbsp. l .;
- motherwort - 4 tbsp. l
The components of the drug collection must be thoroughly mixed in a separate container. Every day, a fresh broth of 3 g of collection and 300 ml of boiling water should be prepared. Infuse the broth for an hour. After filtering, drink 100 ml three times a day.
Enormous benefits for blood vessels will beetroot juice. It is recommended to use it daily at 100-120 ml, after adding honey or diluting the juice with clean water. The components contained in the juice, promotes the breakdown of cholesterol plaques and small blood clots.
Food
For people diagnosed with renovascular hypertension, the diet is indicated on an ongoing basis. It is necessary to limit the consumption of soy, salt, fatty and smoked foods. The benefits for the body will bring seaweed, vegetables, fruits, animal proteins (eggs, milk). It is recommended to eat fatty varieties of fish daily.
Carbohydrates are the basis of dietary nutrition for kidney pathology. Without fail, the amount of protein consumed per day should be calculated. In the conditions of inpatient treatment, patients are prescribed a dietary table No. 7. If you are allergic to eggs, you can replace them with dairy products.