Post Date April, 15 2023
Renal artery stenosis can cause a variety of clinical syndromes, which depends on the degree of hemodynamic changes caused by stenosis, the rate of occurrence and the nature of stenosis. The two major diseases caused by it are ischemic nephropathy and renovascular hypertension.
1、 Clinical manifestations of ischemic nephropathy
Clinically, ischemic kidney disease has a variety of manifestations. Some elderly patients have a hidden onset and often have entered end-stage renal disease. Renal dysfunction and hypertension are often typical symptoms.
Patients with unexplained renal function damage accompanied by the following conditions should be highly suspected: 1. Acute renal failure after ACEI/ARB; 2. The change of volume state has a greater impact on serum creatinine; 3. Associated with hypokalemia; 4. Repeated acute pulmonary edema; 5. Associated with coronary artery disease or peripheral vascular disease; 6. Renal function decreased after aortic endovascular stent implantation.
Hypertension patients should also be considered when they have the following conditions: 1. The patients with normal or well controlled original blood pressure suddenly appear moderate to severe hypertension; 2. Those who are still difficult to control after regular treatment with 3 or more kinds of hypertension drugs; 3. Retinopathy grade 3 (25%~40%); 4. Men over 60 years old with diffuse atherosclerosis signs; 5. There is abdominal or femoral artery murmur.
Ischemic nephropathy can also be manifested as mild proteinuria. If there is rapidly progressive hypertension, proteinuria can increase significantly, but it will also decrease with blood pressure control. In addition, patients may have increased nocturia, decreased urine osmolarity and other renal tubular dysfunction.
Pathology is characterized by extensive ischemic changes in the kidney. The tubulointerstitial lesions are the most prominent, with renal tubular atrophy and renal interstitial fibrosis; The initial manifestations of glomerulus were ischemic shrinkage of capillary loops, dilatation of renal sacs, and ischemic sclerosis of the late glomerulus; Renal vessels can be seen with thickening and sclerosis of intima or hyaline degeneration of arterioles.
2、 Treatment of hypertension with ischemic nephropathy
At present, the treatment of ischemic nephropathy mainly includes drugs and vascular reconstruction. In view of the fact that elderly patients with ischemic nephropathy are often accompanied by high atherosclerotic cardiovascular and cerebrovascular complications, and most of the causes of death are cardiovascular events rather than renal failure, drug treatment is the basis in such patients.
Routine drug treatment includes blood pressure control, statins to reduce blood fat, anti-platelet aggregation, and hyperglycemia control. Since renal artery stenosis can cause or aggravate hypertension, and hypertension is also an independent risk factor for producing and aggravating atherosclerosis (including renal artery stenosis) and accelerating the deterioration of renal function, controlling blood pressure is essential for the prevention and treatment of ischemic nephropathy, and joint hypotension is often used clinically.
If Chinese medicine is used for treatment, it is a relatively new treatment method to clear and expand the renal arterioles with the function of activating blood circulation and removing blood stasis, so as to improve renal ischemia and control blood pressure.
Its advantage is that it is more targeted at the root of the disease and has less side effects. For example, acupoint application, using advanced technology
