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