When the diameter of the renal artery narrows, the renal blood flow worsens significantly. A pathological phenomenon is characteristic of such a disease as renovascular hypertension. This is one of the types of arterial hypertension, which occurs only in 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 disease.
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 such disease is renovascular hypertension.
Syndrome occursagainst the background of vasoconstriction in the kidneys and deterioration of blood circulation. In the absence of timely treatment, the disease can lead to tissue ischemia, renal failure. A violation is diagnosed only in a small number of patients with problems with blood pressure. Renovascular hypertension can affect one or both kidneys.
Pathogenesis
According to studies conducted by experts, the 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 prevents blood flow.
Simultaneously with this process, there is an increased activity of aldosterone and angiotensin in the blood. The first substance is a hormone secreted by the adrenal glands. It is released by angiotensin (an olegopeptide hormone) and only affects the he althy kidney by reducing urine production through sodium retention. This does not allow the kidneys to fully perform their functions of purifying the blood and causes the development of such an ailment as renovascular arterial hypertension.
The pathogenesis of the disease gives an idea of how the syndrome is born, and what needs to be done to restore the proper functioning of the kidneys. With the complete normalization of blood circulation in the affected vessels, the patient's condition improves and the disease recedes.
Causes of disease
Currently doctors callseveral main reasons that can serve as an impetus for the development of a pathological condition. Renovascular (renovascular) hypertension most often occurs against the background of the following diseases:
- Atherosclerosis is the main cause of nephrogenic arterial hypertension. Cholesterol plaques narrow the lumen of the vessels by about half at the site of entry into the kidney. The disease most often affects men aged 40-55 years. In women, pathology usually manifests itself after 60 years.
- Fibromuscular dysplasia of the renal arteries is an inflammatory process in which the structure of the muscular 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's disease is a syndrome associated with inflammatory processes in the aorta and the formation of a blood clot. The disease is also called the pulseless disease. The thickening of the vascular membranes against the background of the destruction and swelling of the vascular tissue leads to vasoconstriction. The disease has an autoimmune etiology.
- Mechanical squeezing of blood vessels - occurs against the background of the formation of tumors, cysts and aneurysms of blood vessels. When blood flow is disturbed, renovascular hypertension develops. What it is and how to deal with this disease will be discussed below.
Clinical picture
Symptomatology of the disease has signs of arterial hypertension and kidney pathologies. The severity of the clinical picture of the disease depends on the form of the course of renovascular hypertension andfactors 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.
Severe renovascular hypertension is diagnosed in most cases. Symptoms of the disease are as follows:
- constantly high blood pressure, not decreasing even with the use of drugs;
- increase in diastolic pressure against the background of normal systolic values;
- 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, sudden jumps in blood pressure should be alarming. This is especially true in cases where the next of kin did not suffer from arterial hypertension and the disease could not be inherited.
Signs of benign and malignant renovascular hypertension
With a slow course of the development of the pathological process, there is a slight increase in the "upper" pressure and a significant increase in the indicators of the "lower" pressure. For example, 130/110 or 140/110 mmHg. Art. At the same time, the patient complains of a general deterioration in the condition, the appearance of shortness of breath, and weakness.
The appearance of symptoms such as blurred vision, severe pain in the back of the head, nausea and vomiting, increased "lower" pressure up to 120 mm Hg. Art. suggests that malignant renovascular disease is developinghypertension. What prediction does the specialist give in this case? Extremely unfavorable, because patients rarely seek qualified medical help in a timely manner.
To make a correct diagnosis and prevent the development of a severe pathology, you should be examined when the first symptoms of hypertension appear.
Diagnostic Methods
At the initial visit, the specialist will refer the patient to a laboratory test. In this case, it is almost impossible to make an accurate diagnosis based only on the symptoms and complaints of the patient. 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 the stenosis of the arteries. Laboratory studies help to differentiate the disease from inflammatory processes in the kidneys.
Instrumental methods of examination are mandatory in cases of suspected development of such a serious disease as renovascular hypertension. Diagnosis usually begins with an ultrasound examination, during which it is possible to determine the size of the kidneys, the presence of neoplasms and cysts, and the abnormal development of the organ.
Angiography is used to study the condition of the vessels of the kidneys. The method allows you to determine the degree of their narrowing due to the introduction of a contrast agent. The diagnostic method has a number of contraindications, which you should first familiarize yourself with.
Evaluate the state of blood flow in the vessels of the kidneys allows Dopplerography. This is one of the methodsultrasound research. However, unlike conventional ultrasound, Doppler helps to obtain more valuable information. It is prescribed for an unidentified etiology of arterial hypertension, to assess the size of neoplasms and blood flow in them, if renal failure is suspected.
Radionuclide urography
Renovascular hypertension is often diagnosed by radionuclide urography. The method involves the introduction of a small amount of a radioactive drug into the body. 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 as a result of 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
Therapy of this type of hypertension presents significant difficulties. The disease often manifests itself in its malignant form and is resistant to drugs. With the rapid development of symptoms of the disease, disturbances in the functioning of the liver, brain, and lungs can occur. Usually in these cases, surgery is performed.
Radical treatments allow (in most cases) to prevent serious consequences. Surgical intervention is carried out only when the kidneys retain their functions. One ofmethods 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 area is reached, the balloon is inflated, which, in turn, opens the microprosthesis located at the end of the catheter. The technique has several advantages - low invasiveness and lack of anesthesia for the operation.
It should be borne in mind that the method described above is not suitable for diagnosing stenosis of vessels located at the mouth of the renal artery or with its complete narrowing. In this case, open surgery is indicated.
If the disease has developed against the background of a tumor, cyst or hematoma, it is necessary to perform a surgical intervention and remove the neoplasm. This will restore blood flow and functionality of the organ.
With a benign course of pathology, it is possible to quite successfully reduce blood pressure, eliminate pain in the kidney area with the help of 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 vasodilatory effects);
- Calcium channel blockers (stabilize calcium levels).
Renovascular hypertension is also treatedusing diuretics and drugs that lower blood pressure. The dosage of medicines 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 provided only by complex therapy in the maximum dosage of drugs.
Folk methods
Treatment of renovascular arterial hypertension can be carried out with the help of folk 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. A good result is the use of wild rose. 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 as tea twice a day.
An infusion of lingonberry leaves will help reduce high blood pressure. Previously, the leaves (2 tablespoons) are crushed and pour 250 ml of boiling water. The resulting mixture is insisted on a water bath for at least half an hour, filtered, cooled and taken in the third part of a glass 3 times a day.
If renovascular hypertension was diagnosed at the initial stage of development, you can prepare an infusion from the following components:
- peppermint - 2 tbsp. l.;
- hawthorn inflorescences - 3 tbsp. l.;
- birch leaves - 3 tbsp. l.;
- bud 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 you should prepare a fresh decoction of 3 g of the collection and 300 ml of boiling water. You need to infuse the decoction for an hour. After straining, the drink is taken 100 ml three times a day.
Beetroot juice will bring great benefits to blood vessels. It is recommended to use it daily in 100-120 ml, after adding honey or diluting the juice with clean water. The components contained in the juice contribute to the breakdown of cholesterol plaques and small blood clots.
Food
People who are diagnosed with renovascular hypertension, the diet is shown on an ongoing basis. It is necessary to limit the consumption of soy, s alt, fatty and smoked foods. Benefits for the body will bring seaweed, vegetables, fruits, animal proteins (eggs, milk). It is recommended to eat fatty fish daily.
Carbohydrates are the basis of dietary nutrition in kidney pathology. It is mandatory to calculate the amount of protein consumed per day. In the conditions of inpatient treatment, patients are prescribed dietary table number 7. If they are allergic to eggs, they can be replaced with dairy products.
