1. KIDNEY & HYPERTENTION 1 Dr. Ruba Nashawati

2. Kidney Hypertension 2

3. How Does Kidney Cause Hypertension? 3

4. Renal Parenchymal Disease Renovascular HTN 4

5. Renal Parenchymal Disease 5

6. Common cause of Secondary HTN Every Parenchymal Kidney Disease May Resolve With original Disease Treatment 6

7. Multifactorial cause Disturbances: Na/water balance K balance Ca balance vasodepressors/prostaglandins 7

8. Renovascular HTN 8

9. BP Syndrome of BP (Systolic/Diastolic) Kidney Arterial Circulation produced by a variety of conditions with Kidney Arterial Circulation 9

10. Two Main Causes 10

11. ASRVD ATHEROSCLEROSIS 75-90% ( more common in OLDER patients) 11

12. FMD FIBROMUSCULAR DYSPLASIA 10-25% (More Common In Young Patients, Females ) 12

13. Others 1.Aortic/Renal Dissection 2.Takayasu’s Arteritis 3.Thrombotic/Cholesterol Emboli 4.Post Transplantation Stenosis 5.Post Radiation 13

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16. FIBROMUSCULAR DYSPLASIA 16

17. Non-Atherosclerotic Arteriopathies Distal Vessel Beyond 1 st 2 cm From Aorta Large & Medium-sized Renal Arteries 17

18. Females Young Females 15-50 Early Onset HTN 15-50 years Asymptomatic  many years Both Both Renal Arteries 18

19. Three Main Types: 1.Medial 1.Medial Fibroplasia,Most Common Intimal 2. Intimal Fibroplasia 3.Periadvential 3.Periadvential Fibroplasia 19

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21. Atherosclerotic Renovascular Disease 21

22. Common most Common cause of RVH 50 >50 years systemic + systemic Atherosclerosis ESRD Can cause ESRD 1 st 2 nd 1 st or 2 nd cm of Renal Artery 22

23. PATHOPHYSIOLOGY 23

24. 24 luminal occlusion 70-80% 70-80% RVH

25. 25  poststenotic P 10-20%(aortic P) plasma Renin Activation

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29. Features of Renovascular Hypertension 29

30. Activation Of (RAS) Early Paroxysmal Symptoms: Sympathetic Nervous System Activation abnormal Circadian Rhythm: Loss Of Nocturnal Pressure Fall 30

31. Accelerated Target Organ Damage Left Ventricular Hypertrophy Microvascular Disease Renal Injury: Fibrosis 31

32. Clinical Feature 32

33. 33 Clinical Feature Essential HTN% Renovascular HTN% Duration <1 Year1224 Age Of Onset >50 Years 915 Family History Of HTN 7146 Grade 3 Or 4 Fundi715 Abdominal Bruit946 BUN>20mg/dl816 K < 3.4 Meq/L816 Urinary Casts920 Proteinuria3246

34. Syndromes Associated with Renovascular Hypertension 34

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36. Early Or Late Onset HTN ( 50) Early Or Late Onset HTN ( 50) Acceleration Of Treated Essential HTN Acceleration Of Treated Essential HTN Deterioration Of Renal Function In Treated Essential Hypertension Deterioration Of Renal Function In Treated Essential Hypertension ARF During Treatment Of HTN ARF During Treatment Of HTN 36

37. Flash Pulmonary Edema Flash Pulmonary Edema Progressive Renal Failure Progressive Renal Failure Refractory Congestive Cardiac Failure Refractory Congestive Cardiac Failure 37

38. Diagnosis 38

39. Goals of Diagnostic Evaluation Establishing: Unilateral Or Bilateral Stenosis Or Stenosis To A Solitary Kidney) Presence And Function Of Stenotic And Nonstenotic Kidneys 39

40. Goals of Diagnostic Evaluation Establishing: Hemodynamic Severity Of Renal Arterial Disease Plan Vascular Intervention: Degree & Location of Atherosclerotic disease 40

41. scan Nuclear Renal scan Renal Artery Duplex Ultrasonography CT Angiography (MRA) 41

42. CONVENTIONAL ANGIOGRAPHY STANDARD 42

43. Therapy 43

44. Goals of Therapy Improved Blood Pressure Control A. Prevent Morbidity & Mortality B. Reduce Medication Requirement 44

45. Goals of Therapy 45 Preservation Of Renal Function  Episodes Of Circulatory Congestion (Flash Pulmonary Edema)  Risk Of Progressive Vascular Occlusion  Loss Of Renal Function

46. Ischemic Nephropathy Azotemic Renovascular Disease Loss Of Renal Function Beyond An Arterial Stenosis Due To Impaired Renal Blood Flow 46

47. Medical Therapy 47

48. Modifiable Cardiovascular Risk Factors weight loss smoking cessation low-dose aspirin 48

49. Statin Therapy. BP Control Target < 140/90 mm Hg + CKD/Diabetes < 130/80 mm Hg 49

50. Renal Revascularization 50

51. Percutaneous Transluminal Renal Fibromuscular Dysplasia Angioplasty and Stenting 51

52. 52 FMD + Long Aneurysmal > 1.5 Cm Surgical Revascularization

53. Atherosclerotic Disease: Endovascular Stents 53

54. 54 Refractory To Medical Therapy Surgical Revascularization

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56. HTN in Kidney Transplantation Same As Native Kidney Immunosuppressive Drugs Graft Artery Stenosis 56

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58. HTN Causes Kidney Diseases &Vice Versa Good Control Of HTN Prevent Kidney Disease 58

59. Don’t Hesitate To Contact Nephrologist When Cr >1 mg/dl 59

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