肾动脉狭窄合并恶性高血压的临床特点

目的了解肾动脉狭窄(RAS)所致恶性高血压(MHT)的发病情况、临床特点和预后。方法回顾性分析北京大学第一医院23年间所有经肾动脉造影证实为RAS的病例,将其中合并MHT的23例列为研究对象,收集其临床及实验室资料,并与同时期收治的46例肾实质性MHT以及23例原发性MHT患者进行比较。结果23例RAS合并MHT患者占同期MHT患者的25.8%、RAS患者的19.5%,其中动脉粥样硬化性肾动脉狭窄(ARAS)在1990年前仅占20.0%,而1990年后已成为首位病因。RAS合并MHT组有别于其他两组的特点包括双侧肾脏大小不一致(52.2%)、血管杂音(17.4%)以及应用血管紧张素转换酶抑制剂(ACEI)后Scr升高超过30%(8.7%)。此外RAS合并MHT组较肾实质性MHT者尿蛋白量低犤(1.6±1.5)g/d比(4.0±3.1)g/d犦,血尿也少见。血压控制满意后RAS合并MHT组尿蛋白转为阴性或降至1.0g/d以下,而肾实质性MHT组尿蛋白无显著下降。RAS合并MHT组行血管重建治疗的11例患者中6例高血压得到完全控制(54.5%)。在3～12个月的随访中RAS合并MHT组中有2例进入维持性透析治疗(均为入院时即存在肾功能不全的患者),少于其他原因引起的MHT患者。结论RAS是继发性MHT常见的病因。对于尿液中有形成分不多、蛋白尿定量<3.5g/d的MHT患者应积极进行RAS的相关筛检。在不同病因导致的MHT中,RA     

Transluminal vascular stent implantation for a patient with renovascular hypertension due to renal artery stenosis

In recent years, transluminal vascular stents have been implanted in patients with renal artery stenosis. At present, controversy remains as to whether the long-term outcome of stent implantation is better than that of percutaneous transluminal renal angioplasty (PTRA). However, until now, no clinical experience of a stent placement for renal artery stenosis has been reported in our country. We implanted a Palmaz stent in a patient with renovascular hypertenstion due to renal artery restenosis who had already undergone PTRA. The renal function and blood pressure of the patient improved remarkably.     

Long-term follow-up of neonatal renovascular hypertension

Twelve neonates with hypertension have been followed for a mean of 5.75 years. At onset of hypertension, mean peak blood pressure was 159/99 mmHg. Ten infants had umbilical artery catheters, 9 placed above the origin of the renal arteries. Radionuclide renal scan, and/or angiography demonstrated renovascular disease, primarily renal artery thrombosis, in 11 infants. Onethird of infants were asymptomatic, one-third had normal urinalyses and two-thirds had elevated peripheral plasma renin activities. Blood pressure normalized with medical therapy in all infants and remained normal when therapy was discontinued. Ten infants have normal creatinine clearances on follow-up but 5/11 have unilateral renal atrophy. Radionuclide scans have remained abnormal, even in infants without renal atrophy. In summary, neonatal renovascular hypertension is frequently secondary to renal artery thrombosis, associated with umbilical artery catheterization. Blood pressure usually normalizes with conservative medical management and remains normal off medications. Persistent abnormalities in renal size and function are common.     

肾血管性高血压的介入治疗

我们评价经皮肾动脉腔内成形术（PTRA）及内支架植入术治疗肾血管性高血压（RVH）的疗效。 一、对象和方法 1．对象：肾动脉狭窄19例，其中男5例，女14例，平均年龄39．3岁（21～73岁），均符合血管成形术适应证，并排除了禁忌证。单侧肾动脉狭窄12例，双肾动脉狭窄7例。肾动脉开口病变4例，非开口病变15例。动脉粥样硬化性狭窄18例，多发性大动脉炎1例，其中4例患者合并肾功能不全。     

肾血管性高血压的介入治疗

目的：研究经皮腔内血管成形术加内支架植入术治疗肾动脉狭窄致致肾血管性高山压的临床效果。方法：选用Palmaz支架,对7例大动脉炎、2例动脉弱样硬化,3例纤维肌性发育不良所致肾动脉病变先行经皮腔内血管成形术,然后放置支架,术后患者行常规抗凝治疗,结果：12例患者,经皮腔内血管成形术加支架植入术技术成功率为100％,血压下降60－120／35－100mmHg近期随访－32个月未见复发,结论：经皮腔内血管成形术加支架植入术治疗肾血管性管高血压效果满意,创伤小,患者痛苦少,为肾动脉狭窄所致肾血管性高血压较理想的治疗方法。     

自体肾移植术治疗顽固性肾血管性高血压的临床价值(附5例报告)

目的:总结采取自体肾移植术(renal autotransplantation,RAT)治疗因重度肾动脉狭窄(renal artery stenosis,RAS)所致顽固性肾血管性高血压(intractable renal vascular hypertension,IRVH)的经验并探讨其临床应用价值。方法:回顾性分析武汉协和医院收治5例IRVH患者的临床资料及随访结果,观察术后患者血压改善情况及移植肾功能状况,并复习相关文献。结果:4例单侧重度RAS患者术后血压均降至正常范围,于术后20~35天停服降压药物。1例双侧RAS患者左侧行自体肾移植术后血压明显下降,出院后1个月右侧行经皮腔内肾动脉支架成形术(percutaneous transluminal renal artery stenting PTRAS),术后63天停服降压药物。随访6个月~3年,5例患者血压维持在正常范围,移植肾功能正常。结论:针对于肾动脉重度狭窄的患者,当无法行PTRAS术时,RAT可作为首选的治疗方法,而且疗效确切。     

肾动脉硬化致肾血管性高血压的介入治疗

自 1995年 2月至 2 0 0 1年 12月我院采用介入治疗肾动脉硬化、肾血管性高血压 38例 ,现报告如下。材料与方法　本组 38例。男 2 7例 ,女 11例。年龄 5 8～ 76岁 ,平均 6 5岁。 38例均有高血压表现 ,其中 2 0例有原发性高血压病史 ,近期 (3～ 18个月 )血压明显升高 ,降压药物效果不好。收缩压 (2 12± 2 3)mmHg(1mmHg =0 .133kPa)。余 18例病程 2～ 4 8个月。收缩压 (2 0 8± 19)mmHg。动脉造影示单侧肾动脉受累 2 8例 ,双侧受累 10例。开口部病变 2 7段 ,中远端病变 2 1段。狭窄段长度 (16 .2±4 .8)mm ,狭窄远近端压力阶差 (5 2± 16 )m…     

肾血管性高血压治疗进展

肾血管性高血压治疗进展王仁顺作者单位：４１０００３长沙，解放军第一六三医院肾血管性高血压（ＲＶＨ）为肾素依赖性，常伴血管紧张素Ⅱ（ＡⅡ）和醛固酮的升高，形成体内的升压体系（ＲＡＡＳ）。ＡⅡ可促进肾小球和间质细胞外基质沉积，纤维和胶原增生，发展为肾硬化...     

副肾动脉引起肾血管性高血压

副肾动脉变异的研究常见于肾脏移植、肾肿瘤切除等腹膜后手术，但其与高血压的关系，国内鲜有报道。     

肾血管性高血压论断和治疗和进展

在肾血管性高血压的诊断中，肾血管造影仍被认为是准确性最高的检查方法，但侵入性、操作复杂、造影剂毒性等因素限制了其广泛应用。经皮血管成形术对肾血管性高血压的治疗引起了人们很大兴趣，但因远期效果欠佳阻碍其进一步发展。近年来新材料、新技术的应用，一些特异性、敏感性较高，侵袭性小或无创性新方法的出现，使肾血管性高血压的诊断和治疗发生了很大变化，不仅提高了诊断的准确性和治疗效果，还减轻了病人的痉和并发症，充     

介入治疗肾血管性高血压

目的总结经皮腔内血管成形术（ＰＴＲＡ）＋内支架植入术治疗肾血管性高血压的疗效。方法１９９５～１９９８年介入治疗肾血管性高血压患者２６例。对肾动脉硬化导致的肾动脉近端病变直接行支架植入术。对肾动脉硬化致肾动脉中远端病变及大动脉炎,纤维肌肉发育不良性肾动脉病变先行ＰＴＲＡ术,效果不好或失败者行支架植入术。选择Ｐａｌｍａｚ支架。结果ＰＴＲＡ＋支架植入术技术成功率１００％,近期临床治愈改善率９２．３％,随访治愈改善率８６．４％。结论ＰＴＲＡ＋支架植入术即时安全有效,治愈改善率满意,可作为肾血管性高血压的首选治疗方法。     

Percutaneous transluminal angioplasty for renovascular hypertension in children

Percutaneous transluminal angioplasty (PTA) has been developed over the past 8 years as an alternative to reconstructive surgery for renovascular hypertension. We report three cases and review the use of PTA in children with renal artery stenosis. At least 37 cases of PTA have been reported in patients whose ages ranged from 1.3 to 17 years (mean 10 years). Of these, 10 had fibromuscular dysplasia; 13 unspecified unilateral renal artery stenosis; 4 bilateral stenosis; 4 neurofibromatosis; 4 renal transplant; 1 atherosclerosis; and 1 postsurgical stenosis. Nine of 10 patients with fibromuscular dysplasia were cured and 3 of 4 with renal transplant arterial stenosis were cured or improved. There were 11 failures of PTA, including all 4 patients with neurofibromatosis and 1 with transplant arterial stenosis. We conclude that PTA is the treatment of choice for children with hypertension due to fibromuscular dysplasia and should be attempted for stenosis of the transplanted renal artery. Other lesions resulting in renal artery stenosis may not be as amenable to dilation and should be considered on an individual basis.R. L. Chevalier is an Established Investigator of the American Heart Association     

Severe renovascular hypertension in an infant with congenital solitary pelvic kidney

Renal artery stenosis (RAS) is one of the most common causes of severe arterial hypertension in infants. Its management is very difficult, especially when present in a single kidney. We report a case of severe hypertension caused by RAS of congenital single pelvic kidney in a 4-month-old boy. The patient presented with cardiorespiratory insufficiency that was first treated as acute fulminate myocarditis. Medical treatment of arterial hypertension was disappointing, as it had to be balanced between congestive cardiac failure and acute renal failure. Percutaneous transluminal angioplasty (PTA) done by coronary balloon dilatation catheters through the left axillary access was successful. Following dilatation of the renal artery, blood pressure decreased and its good control was possible by only one drug. With improved medical blood pressure control and normal growth development, the reassessment of clinical therapy options adjusted to a larger vessel size would be possible. Renovascular hypertension due to RAS in infants with a solitary kidney is difficult to control by medical treatment alone. PTA should be considered as a viable option in infants with refractory hypertension due to renal artery stenosis in a solitary kidney, since it has the potential of improving hypertension while preserving renal function.     

Imaging for renovascular disease

Renal artery stenosis is frequently considered in the diagnosis of severe hypertension and renal insufficiency, but the benefits of screening and the choice of imaging modalities is controversial. Sonography, computed tomography angiography (CTA), magnetic resonance angiography (MRA), and conventional angiography are all used and each has advantages and disadvantages. However, performance and interpretation of each requires significant experience and expertise. Since there are no clear data or consensus on the choice of imaging modalities, this should be based on the level of expertise that is available.     

The management of pediatric renovascular hypertension: a single center experience and review of the literature

Introduction

Renal artery occlusive disease is poorly characterized in children; treatments include medications, endovascular techniques, and surgery. We aimed to describe the course of renovascular hypertension (RVH), its treatments and outcomes.

Renal-portal shunt ameliorates renovascular hypertension in pigs

BACKGROUND: Renovascular hypertension is the most common curable form of secondary hypertension. Renin angiotensin system activation depends on the balance between renin production by the kidney and renin degradation by the liver. Thus, we aimed to examine whether deviation of renin-rich blood from the affected kidney into the portal circulation (portalization) can ameliorate renovascular hypertension. METHODS: We selected a porcine model of unilateral renal artery stenosis because the pig's anatomy and physiology are comparable to those of humans and because pigs have already been found capable of developing chronic renovascular hypertension. Angiography and ultrasonography were deliberately used to evaluate renal artery stenosis and the renal-portal shunt. Histology was used to examine the effects of portalization on the kidney and liver after a period of two months. RESULTS: As expected, following the creation of a left renal artery stenosis both renin activity and mean blood pressure measurements increased from 1.23 +/- 0.06 ng/mL/h and 85.6 +/- 0.5 mm Hg at baseline to 4.59 +/- 0.02 ng/mL/h and 126 +/- 1.76 mm Hg, respectively. After portalization renin activity returned to the normal range (1.59 +/- 0.07 ng/mL/h) followed by a concomitant reduction of mean blood pressure to 91 +/- 2 mm Hg. Moreover, a significant correlation was observed between changes in renin activity and blood pressure measurements during the two stages of the experiment. Both the kidney and liver remained macroscopically and microscopically intact at the end of the experiment. CONCLUSION: Portalization of the affected kidney can ameliorate renovascular hypertension and therefore, it might be of benefit in those individuals with fibromascular or atheromatous lesions in the renal artery or its branches not amenable to balloon angioplasty or surgical revascularization.