Renal Artery Stenosis And Renal Artery Occlusion

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A renal artery stenosis is a decrease of blood flow through one or both of the main renal arteries or their branches. A closure of the renal arteries is a complete blockage of blood flow through one or both of the main renal arteries or their branches. Stenosis and closure usually arise due to thromboembolism, atherosclerosis or fibromuscular dysplasia. The symptoms of acute occlusion are constant stabbing flank pain, abdominal pain, fever, nausea, vomiting and hematuria. It may develop acute renal injury. A progressive chronic stenosis causes a persistent high pressure and can lead to chronic kidney disease. The diagnosis is made by imaging methods (eg. B. CT, angiography or magnetic resonance angiography). The treatment of acute closure consists of the administration of anticoagulants and fibrinolytics, and sometimes a surgical or Katheterembolektomie or a combination of both. The treatment of a chronic progressive stenosis is the angioplasty with stent or a surgical bypass.

The renal hypoperfusion results in renovascular hypertension, renal failure, and – if a complete closure occurs – to renal infarction and Nierennekrose.

A renal artery stenosis is a decrease of blood flow through one or both of the main renal arteries or their branches. A closure of the renal arteries is a complete blockage of blood flow through one or both of the main renal arteries or their branches. Stenosis and closure usually arise due to thromboembolism, atherosclerosis or fibromuscular dysplasia. The symptoms of acute occlusion are constant stabbing flank pain, abdominal pain, fever, nausea, vomiting and hematuria. It may develop acute renal injury. A progressive chronic stenosis causes a persistent high pressure and can lead to chronic kidney disease. The diagnosis is made by imaging methods (eg. B. CT, angiography or magnetic resonance angiography). The treatment of acute closure consists of the administration of anticoagulants and fibrinolytics, and sometimes a surgical or Katheterembolektomie or a combination of both. The treatment of a chronic progressive stenosis is the angioplasty with stent or a surgical bypass. The renal hypoperfusion results in renovascular hypertension, renal failure, and – if a complete closure occurs – to renal infarction and Nierennekrose. Etiology A closure may be acute or chronic. An acute closure occurs on one side in most cases. A chronic closure can occur on one or both sides. Acute renal artery occlusion The most common cause is a thromboembolism. The emboli originating from the heart (due to atrial fibrillation, myocardial infarction, or in bacterial endocarditis due to vegetation) or from the aorta (as Atheroemboli). Less common are fat – or the cause tumor emboli. Thrombosis can arise spontaneously in a renal artery, or after trauma, surgical intervention, angiography or angioplasty. Other causes of acute closure can be a renal artery aneurysm, the aortic dissection and rupture. A quick total occlusion of large renal arteries over 30-60 minutes leads to infarction. The infarct is typically wedge-shaped and radiates from the affected vessel to the exterior aus.Chronisch progressive renal Over 90% of cases are caused by atherosclerosis, which is usually bilateral. Nearly 10% of cases are due to fibromuscular dysplasia (FMD), which is often one-sided. Less than 1% of cases are due to the Takayasu’s arteritis, Kawasaki’s syndrome, neurofibromatosis type 1, a Aortenwandhämatoms or an aortic dissection. Arteriosclerosis primarily of> 50 years (mostly men) develops in patients and usually affects the Aortenabgang or the proximal segment of the main renal artery. A chronic progressive stenosis is clinically that a renal atrophy and chronic kidney failure have arisen only after about 10 years of atherosclerosis, to identify. FMD is a pathological thickening of the arterial wall, usually the distal main artery or intrarenal branches. The thickening tends to be irregular and (usually but the media) include any layer. This change is mainly developed in young adults, especially in women aged 20-50 years. It is more common in first-degree relatives of patients with FMD and in people with the ACE1 gene. Symptoms and complaints The manifestations depend on the rate, magnitude, whether it occurs one or both sides and duration of renal hypoperfusion from. Stenosis of the renal artery is often asymptomatic for a remarkably long time. An acute, complete occlusion of one or both renal arteries causes a constant and stabbing flank pain, abdominal pain, fever; Nausea and vomiting. It can set a gross hematuria, oliguria or anuria, but hypertension is rare. After 24 hours, the symptoms and signs of acute Nierenachädigung develop. Was the cause of thromboembolism, indications of thromboembolism in other places can occur (eg. As in the fundoscopy blue toes, cutis marmorata or livedo reticularis, retinal lesions). The chronic progressive stenosis causes hypertension, which occurs in an atypical age (z. B. <30 or after age 50), and despite the administration of various antihypertensive drugs is refractory to treatment. Physical examination may reveal abdominal vascular sounds or signs of atherosclerosis. Symptoms of chronic kidney disease develop slowly. Diagnosis Clinical suspicion Imaging Techniques The suspected diagnosis is made in patients with renal failure and in patients who have: symptoms of acute renal artery occlusion symptoms or complaints from thromboembolism hypertension that begins before age 30, or is refractory to treatment with> 3 antihypertensive renal artery stenosis (magnetic resonance angiography) imaging provided by Jan N. Basile, MD var model = {thumbnailUrl: ‘/-/media/manual/professional/images/renal_artery_stenosis_magnetic_resonance_angiography_high_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/-/media/manual/professional/images/renal_artery_stenosis_magnetic_resonance_angiography_high_de.jpg?la = en & thn = 0 ‘, title:’ renal artery stenosis (magnetic resonance angiography) ‘description:’ u003Ca id = “v37896969 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “” para “” u003e u003cp u003eSchwere stenosis at the origin of the left renal artery in magnetic resonance angiography u003c / p u003e u003c / div u003e ‘credits’. Figure provided by Jan N. Basile

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