home Audience 5 Recommendations for the treatment of renal artery stenosis. Renal artery stenosis arterial hypertension

Recommendations for the treatment of renal artery stenosis. Renal artery stenosis arterial hypertension

Renal artery disease

Clinical manifestations

Stenosis renal artery causes two syndromes: arterial hypertension and ischemic nephropathy. Damage to the renal arteries may indicate abrupt start arterial hypertension (before 50 years of age this is often fibromuscular dysplasia, after 50 years of age - atherosclerosis), development of resistance to antihypertensive therapy. The only manifestation of renal artery stenosis may be chronic renal failure of unknown origin, including while taking ACE inhibitors.

Severe renal artery stenosis can lead to recurrent pulmonary edema, often with normal left ventricular contractility. Pulmonary edema develops due to volume overload and vasoconstriction caused by the action of renin and angiotensin. On physical examination, renal artery stenosis is manifested by a murmur over the lateral abdomen, and by ophthalmoscopy - signs of hypertensive retinopathy.

Etiology and course

The most common causes of renal artery stenosis are atherosclerosis and fibromuscular dysplasia.

Atherosclerosis- the cause of renal artery stenosis in 90% of cases, typically affecting the mouth and proximal third of the arteries. The prevalence of atherosclerosis of the renal arteries increases with age, it is especially high in patients with diabetes mellitus, damage to the aorta and iliac arteries, coronary artery disease and arterial hypertension. Renal artery stenosis is the most common cause of symptomatic hypertension, accounting for 1-5% of all cases arterial hypertension and causes 20% of cases of chronic renal failure requiring hemodialysis. This is an independent unfavorable prognostic factor in patients with damage to other arteries. In addition, patients with renal artery stenosis have the least favorable prognosis of all those undergoing hemodialysis.

Fibromuscular dysplasia(it usually affects the media) causes renal artery stenosis in less than 10% of cases. Most often women aged 15 to 50 years are affected. Characteristically, the distal two thirds of the renal artery and its branches are affected; on angiography, the arteries resemble a rosary. The etiology of fibromuscular dysplasia is unknown.

TO rare reasons renal artery stenosis includes vasculitis, neurofibromatosis and radiation; In addition, renal artery stenosis can be congenital; it can also occur due to compression of the artery from the outside.

Diagnostics

Laboratory research

Blood urea nitrogen (BUN) and serum creatinine are the most accessible indicators, and they usually begin the examination. Although increases in BUN and serum creatinine are insensitive and nonspecific for renal artery stenosis, they are often the first indication of the disease. Urinalysis reveals proteinuria and scanty urinary sediment. Previously, they resorted to a complex assessment of the state of the renin-angiotensin system, but with the advent of highly informative non-invasive methods studies of the renal arteries have become optional.

Duplex ultrasound of the renal arteries

The rate of blood flow in the renal arteries is used to assess the severity of the stenosis because blood flow accelerates as it passes through the narrowing. It's inexpensive and available method, but it requires highly qualified researchers. Duplex ultrasound of the renal arteries is difficult in obesity and flatulence.

Renal scintigraphy

Renal scintigraphy compares the perfusion of the right and left kidneys. Prescribing captopril before scintigraphy increases its informativeness, since it reduces glomerular filtration in the affected kidney and the difference in perfusion becomes more noticeable. Scintigraphy with captopril is especially informative for fibromuscular dysplasia; in atherosclerotic renal artery stenosis it is much less sensitive, since in these patients the activation of the renin-angiotensin system is less pronounced. In addition, scintigraphy allows you to measure the glomerular filtration rate separately for each kidney.

Magnetic resonance angiography

Magnetic resonance angiography provides rapid imaging of the aorta and renal arteries. Gadolinium used as a contrast agent does not have nephrotoxic properties. The advantages of magnetic resonance angiography include non-invasiveness and the possibility of three-dimensional reconstruction of the affected area. The disadvantages of the method are its high cost, relatively low availability, inability to distinguish severe stenosis from occlusion, and a tendency to overestimate the severity of stenosis. After stenting, magnetic resonance angiography is not very informative due to interference.

Selective renal arteriography

Selective renal arteriography is the reference method for diagnosing renal artery stenosis. It requires arterial access and the introduction of radiocontrast agents. For severe renal failure(GFR less than 10–20 mL/min), gadolinium-based agents or carbon dioxide should be used instead of iodinated contrast media. With catheterization, the hemodynamic significance of stenoses can be assessed.

Treatment

Renal artery stenosis usually progresses despite antihypertensive therapy, which is accompanied by ischemia and decreased renal function. The basis of atherosclerotic nephropathy, however, is not only stenosis of the renal arteries. Histological examination shows that a decrease in kidney function is also caused by atheroembolism of small arteries, stenosis of intrarenal arteries and hypertensive nephrosclerosis. As with lesions of other peripheral arteries, one should always be alert for atherosclerosis of the coronary and cerebral arteries.

Drug treatment

Active combination antihypertensive therapy is carried out. Exactly antihypertensive therapy usually serves as the standard against which the effectiveness of angioplasty is compared and surgical treatment renal artery stenosis in clinical trials.

Angioplasty of the renal arteries

It is believed that early restoration of renal blood flow in atherosclerotic renal artery stenosis facilitates the treatment of arterial hypertension and slows the progression of renal failure. However arterial hypertension and renal failure may simply accompany renal artery stenosis without being its consequence. Two small randomized trials have shown that renal artery angioplasty reduces systolic blood pressure and reduces the need for antihypertensive drugs Oh. This effect in fibromuscular dysplasia is more pronounced than in atherosclerotic stenosis of the renal arteries, which is understandable given the multi-level damage to the renal arteries in atherosclerosis.

Renal artery stenting is now increasingly used, although data on its effectiveness are based only on clinical observations and historically controlled studies. There are no randomized trials comparing stenting with balloon angioplasty without stenting. Clear recommendations for angioplasty and stenting of the renal arteries have not yet been developed.

Surgery

Two types of intervention are possible: bypass surgery (aortorenal, transrenal and mesenteric) and endarterectomy. Perioperative mortality is 1-6%. Surgeries for renal artery stenosis are being performed less and less often, since angioplasty gives comparable results, but is safer. When renal artery stenosis is combined with aneurysm or aortic obstruction, primacy, however, remains with bypass surgery.

Renal artery stenting- probably the most common and at the same time least studied intervention to restore vascular patency. A large randomized trial is needed comparing renal artery stenting with conservative treatment. The latter should include the elimination of risk factors, active antihypertensive and lipid-lowering therapy and aspirin. It is necessary to study the effect of renal artery stenting on mortality, progression of renal failure, and the course of arterial hypertension. A special report from the American Heart Association issued in 2002 introduced standard criteria for diagnosis, testing, and outcome recording for randomized clinical trials.

Literature:

Renal artery stenosis

admin | 02.11.2014

Stenosis means “narrowing.” Renal artery stenosis is a significant narrowing of the lumen blood vessels, feeding the kidneys, due to their blockage with atherosclerotic plaques. In elderly patients with type 2 diabetes mellitus, this is one of the common causes of kidney failure. Renal artery stenosis also causes severe hypertension, which is practically untreatable.

The volume of blood that the renal arteries can pass through provides the necessary supply of oxygen to the organs in excess. Therefore, renal artery stenosis for a long time can develop without any symptoms. Complaints in patients usually appear when the patency of blood vessels is impaired by 70-80%.

Who is at risk for renal artery stenosis?

In patients with type 2 diabetes mellitus, renal artery stenosis is especially common. Because they first develop metabolic syndrome. and then the blood sugar remains steadily elevated. These metabolic disorders cause atherosclerosis, i.e. blockage of large main vessels that supply the heart and brain. At the same time, the lumen in the arteries feeding the kidneys narrows.

Diabetes and kidneys: useful articles

In the USA, the survival of patients with renal artery stenosis was studied for 7 years. It turned out that such patients have a huge risk of cardiovascular disaster. It is approximately 2 times higher than the risk of kidney failure. Moreover, surgical restoration of the patency of the renal vessels does not reduce the likelihood of dying from a heart attack or stroke.

Renal artery stenosis can be unilateral (monolateral) or bilateral (bilateral). Bilateral is when the arteries supplying both kidneys are affected. Unilateral - when the patency in one renal artery is impaired, and in the other it is still normal. The branches of the renal arteries may also be affected, but the great vessels are not.

Atherosclerotic stenosis of the renal vessels leads to chronic ischemia (insufficient blood supply) of the kidneys. When the kidneys “starve” and “suffocate,” their work deteriorates. At the same time, the risk of renal failure increases, especially in combination with diabetic nephropathy.

Symptoms and diagnosis

Risk factors for renal artery stenosis are the same as for “normal” atherosclerosis. Let's list them:

high blood pressure;
excess body weight;
male gender;
increased levels of fibrinogen in the blood;
elderly age;
smoking;
poor levels of cholesterol and fats in the blood;
diabetes.

It can be seen that most of these risk factors can be corrected if the diabetic took care of his health at a young or middle age. If stenosis of one of the renal arteries has developed, then the likelihood increases that the second one will also suffer.

A doctor may suspect renal artery stenosis in a patient with diabetes if the following symptoms and objective data are present:

the patient's age exceeds 50 years;
renal failure progresses, at the same time proteinuria< 1 г/сутки и изменения в мочевом осадке минимальные;
severe arterial hypertension - blood pressure it is very elevated, and it is not possible to lower it with medications;
Availability vascular pathology (ischemic disease heart, blockage of large vessels, murmurs in the projection of the renal arteries);
when treated with ACE inhibitors - an increase in creatinine;
the patient has been smoking for a long time;
When examined by an ophthalmologist, there is a characteristic picture of Hollenhorst plaques on the retina.

Can be used for diagnostics various methods studies that provide a visual picture of the condition of the renal arteries. Their list includes:

Ultrasonic duplex scanning(ultrasound) of the renal arteries;
Selective angiography;
Magnetic resonance angiography;
Computed tomography (CT);
Positron emission tomography (PET);
Scintigraphy with captopril.

Some of these methods require injection into the bloodstream contrast agents, which can have a nephrotoxic effect, i.e. harm the kidneys. The doctor prescribes them if potential benefit from clarifying the diagnosis exceeds possible risk. This is especially true in cases where it is planned surgery to restore the patency of the renal arteries.

Treatment of renal artery stenosis

For successful treatment Renal artery stenosis requires constant comprehensive efforts to stop the development of the atherosclerotic process. The main responsibility for them lies with the patient himself and his family members. Add to list necessary measures includes:

to give up smoking;
normalization of blood glucose levels;
demotion blood pressure to normal;
when overweight body - weight loss;
prescription of medications - anticoagulants;
taking drugs from the statin class to improve cholesterol and triglyceride levels in the blood.

We recommend a low-carbohydrate diet for type 1 and type 2 diabetes. This The best way to lower your blood sugar to normal and thus protect your kidneys from diabetic lesion. A low-carbohydrate diet not only lowers sugar, but also normalizes triglycerides, “good” and “bad” cholesterol in the blood. Therefore she is a powerful tool to slow down atherosclerosis, including inhibition of renal artery stenosis. Unlike statin drugs, dietary treatment has no harmful side effects. The section of our website “Diet for kidneys in diabetes” is very important for you.

Renal artery stenosis and medications

For diabetic kidney problems, patients are often prescribed medications from the groups of ACE inhibitors or blockers angiotensin-II receptors(BRA). If the patient is diagnosed with unilateral renal artery stenosis, it is recommended to continue taking the medication. And if the renal artery stenosis turns out to be bilateral - ACE inhibitors and BRA needs to be abolished. Because they can contribute to further deterioration of kidney function.

Medicines from the statin class lower the level of “bad” cholesterol in the blood. This often allows atherosclerotic plaques in the renal arteries to be stabilized and prevented from occurring. further progression. At atherosclerotic lesion renal arteries, patients are often prescribed aspirin. At the same time, the feasibility and safety of its use in such a situation has not yet been proven and requires further study. The same applies to low molecular weight heparins and glycoprotein receptor blockers.

Indications for surgical treatment of renal artery stenosis (American Heart Association, 2005):

Hemodynamically significant bilateral renal artery stenosis;
Stenosis of the artery of the only functioning kidney;
Unilateral or bilateral hemodynamically significant stenosis of the renal arteries, which led to uncontrolled hypertension;
Chronic renal failure with unilateral stenosis;
Recurrent cases of pulmonary edema with hemodynamically significant stenosis;
Unstable angina with hemodynamically significant stenosis.

Note. Hemodynamics is the movement of blood through the vessels. Hemodynamically significant vessel stenosis is one that actually impairs blood flow. If the blood supply to the kidneys remains adequate despite renal artery stenosis, the risks of surgery may outweigh the potential benefits.

Renal artery stenosis may be suspected if sharp increase blood pressure. It manifests itself as headache, tinnitus, pain in the eye area, flickering spots in the eyes, and sleep disturbances. Shortness of breath, palpitations, pain in the heart area, and a feeling of heaviness behind the sternum are also typical. A person is bothered by lower back pain, and there may be blood in the urine. But often renal artery stenosis has almost no symptoms.

Long-term stenosis of the renal artery leads to azotemia (excess in the blood of nitrogen-containing products of protein metabolism - urea, uric acid, creatine), which manifests itself constant fatigue, weakness, confusion.

Description

Normally, blood passes through the kidneys, where it is filtered, producing primary urine, which is close in density to blood plasma. With renal artery stenosis, less blood flows to the kidney, it is filtered less well, which increases blood pressure. In addition, due to the small supply of blood to the kidney, its function is impaired, and as a result, renal failure occurs. Over time, if this process is not brought under control, the kidney shrinks and ceases to perform its functions.

Renal artery stenosis can be suspected in patients over 50 and under 30 years of age with a sharp, constant and unjustified increase in pressure. Causes of renal artery stenosis:

inflammation of the artery;
dissecting arterial aneurysm;
compression of an artery by a tumor;
fibromuscular dysplasia, thickening of the muscles of the artery walls.

But regardless of the cause, renal artery stenosis has an adverse effect on the functioning of the body as a whole, since it is disrupted hormonal balance body, due to poor filtration in the kidney, protein loss occurs and fluid excretion is impaired. All this leads to changes in the total volume of circulating blood, the condition of blood vessels and internal organs. And even medications may act differently in the body of a person suffering from renal artery stenosis.

Therefore, if your blood pressure has risen sharply, and the medications prescribed by your doctor are of little help, get tested for renal artery stenosis.

Diagnostics

The presence of this disease is usually determined using ultrasound examination(Dopplerography), CT angiography, arteriography, urography, scintigraphy. Additionally, to determine the causes of stenosis, general and biochemical blood tests, urine tests are performed, kidney function indicators are examined and the level of electrolytes is determined. Sometimes perfusion is assessed - the volume of blood flowing to the kidney through a stenotic artery.

Studies help not only to determine the location and cause of narrowing of the artery, but also to differentiate it from tumors and cysts.

Diagnostics are selected individually for each patient, so if you haven’t done anything from this list, don’t be upset, perhaps this study is not needed in your particular case.

Treatment

First of all, you need to reduce the pressure. To do this, use a combination of antihypertensive drugs with diuretics. In this case, it is necessary to monitor the functioning of the kidneys, since treatment can lead to its impairment. If renal artery stenosis does not manifest itself in any way, you just need to monitor your blood pressure and periodically take a urine test to monitor your kidney function, so that if the situation worsens, you can start treatment on time.

If the lumen of the vessel is narrowed by more than 70%, drug therapy is ineffective, then the only way to restore the lumen of the vessel, blood supply to the kidney and its excretory function is surgical intervention.
In patients with bilateral stenosis, balloon angioplasty is effective. In this case, through the femoral artery special catheter A balloon is inserted into the area of narrowing of the renal artery, inflated, and thereby dilates the artery.

The concept of “renal artery stenosis” implies a narrowing of its lumen in comparison with the diameter of this artery in healthy person. This leads to decreased renal perfusion and the development of chronic diseases kidneys, which are characterized by a decrease in glomerular filtration and increasing nephrosclerosis. Stenosis is considered hemodynamically significant, leading to a decrease in the lumen of the artery by 50% or more. However, in the presence of factors that aggravate the blood supply to the kidneys, symptoms of the disease may appear with less significant narrowing of the vessel.

Causes

One of the common causes of renal artery stenosis is atherosclerosis.

There are many various reasons, which can cause damage to the renal arteries. These include:

fibromuscular dysplasia;
vasculitis and nonspecific aortoarteritis;
renal artery hypoplasia;
compression of the main artery of the kidneys from the outside (for example, by a tumor);
coarctation of the aorta;
embolism, thrombosis, etc.

Most common cause Renal artery stenosis is considered atherosclerosis. About 40-65% of cases of this pathology are associated precisely with the narrowing of the lumen of the vessel by an atherosclerotic plaque, which can be located in the aorta and descend into the renal artery or be located directly in the latter.

Atherosclerotic stenosis can be unilateral or bilateral. It accounts for at least 15% of all cases of arterial hypertension, primarily considered essential.

Factors predisposing to atherosclerotic lesions of the renal arteries:

elderly age;
hereditary predisposition;
smoking;
and etc.

A decrease in the lumen of the renal arteries leads to a decrease in pulse pressure in its branches and insufficient blood supply to the kidney tissue. In response to this, hyperplasia of the juxtaglomerular apparatus occurs and the concentration of renin, which is produced by the cells of this apparatus, increases. As a result, angiotensinogen 2 accumulates in the blood, which is a powerful vasoconstrictor (narrows blood vessels) and increases the secretion of aldosterone and the retention of sodium and water in the body. For some time, angiotensin 2 maintains the tone of the afferent and efferent arterioles of the glomerulus, which helps maintain sufficient level glomerular filtration, and adequate blood supply to the renal structures. But as it progresses pathological process Arterial hypertension increases, renal function deteriorates and nephrosclerosis develops.

In second place among pathological conditions leading to renal artery stenosis is fibromuscular dysplasia. It is more often detected in females under the age of 45 years. In this case, the distal or middle parts of the artery are usually affected. The narrowing itself is a consequence of hyperplasia covering the vessel in the form of a ring. In 50% of patients, the lesion can be bilateral.

In 16-22% of cases, narrowing of the renal arteries is caused. This autoimmune disease from the group of vasculitis, affecting the aorta and its branches. Young women and children are more predisposed to it.

Renal vascular stenosis due to other causes is much less common.

Symptoms

Clinical signs of renal artery stenosis are not specific. On initial stages illness, as a rule, there are no complaints. Only in some patients are detected and emotional lability. When auscultating the abdomen, a murmur is often heard in the upper part of the abdomen on one or both sides.

As stenosis increases and compensatory capabilities are exhausted, the patient's condition worsens.

The early and main symptom of this pathology is arterial hypertension, which is poorly sensitive to treatment. Sometimes the only objective sign of the disease may be an increase in diastolic pressure.

If the cause of arterial hypertension is atherosclerotic stenosis, then in such patients other manifestations of atherosclerosis are usually detected (intermittent claudication). In addition, the following signs attract attention:

early onset and persistent hypertension;
high blood pressure numbers: systolic - above 200 mm Hg. Art., diastolic - more than 130-140 mm Hg. Art.;
rapid increase in its symptoms;
unfavorable variations in daily pressure fluctuations (poorly decreases and continues to increase at night);
resistance to;
deterioration in the functional capacity of the kidneys (decrease in glomerular filtration rate and increase in creatinine in the blood);
a large number of complications (,).

Moreover, the prescription of ACE inhibitors and angiotensin receptor blockers not only does not reduce blood pressure, but also aggravates kidney function. The use of non-steroidal anti-inflammatory drugs and diuretics also contributes to the increase in renal failure.

Cholesterol embolism of the renal arteries plays a certain role in the deterioration of kidney function as a result of disruption of the integrity of the fibrous cap of the atherosclerotic plaque when its condition is destabilized (injury, drug use). large doses anticoagulants). Clinically this is manifested by the following symptoms:

lower back pain;
oligo- or anuria;
changes in urinary sediment (leukocyturia, hematuria);
increase in creatinine in the blood;
hyperkalemia.

In addition to the renal vessels, the following may be affected:

cerebral arteries (severe headaches, nausea, vomiting, stroke);
retina (hemorrhage, swelling of the optic nerve);
vessels digestive system (intestinal obstruction ischemic genesis, gastrointestinal bleeding);
skin vessels (livedo reticularis, trophic disorders).

In elderly patients this pathology may be combined with other kidney diseases:

urate nephropathy;
drug-induced kidney damage.

Diagnostic principles

The doctor may suspect the presence of renal artery stenosis in a patient based on the totality of clinical signs and features of the course of the disease. However, it can only be confirmed instrumental methods research:

Ultrasound examination with Dopplerography (used at the initial stage of diagnosis, since the technique is minimally invasive and does not require the introduction of contrast agents).
Computed tomography of the kidneys with angiocontrast (provides the opportunity to reliably assess the size of the kidneys, the degree of narrowing of the renal arteries and identify the presence of atherosclerotic plaques in them).
Magnetic resonance imaging (highly informative, but limited in use due to high cost).
Contrast angiography (most exact method diagnostics, allowing to identify changes in the lumen of the renal arteries; is associated with risks of worsening kidney function and developing cholesterol embolism).
Radioisotope scintigraphy (the results of the captopril test indirectly indicate damage to the renal arteries).
(reveals delayed removal of contrast on the affected side).

Laboratory studies complement the data obtained, among them the following are mandatory:

(creatinine, urea);
determination of lipid metabolism indicators;
calculation of glomerular filtration rate.

Treatment

Stenting will help restore the patency of the renal artery.

For renal artery stenosis, the main treatment method is surgery. The extent of the operation depends on the extent of the pathological process and the location of the narrowing in the artery.

In persons with high surgical risk, percutaneous endovascular dilatation and stenting are performed.
For isolated atherosclerotic lesions of the renal vessels, endarterectomy is performed.
For fibromuscular dysplasia, resection of the affected area of the vessel is performed, followed by the formation of anastomosis or prosthetics.
For nonspecific aortoarteritis, corrective surgery is performed not only on the renal arteries, but also on the aorta.
Established kidney atrophy and inability to perform its function is an indication for nephrectomy.

Drug therapy for renal artery stenosis is considered not physiological, since the use of antihypertensive drugs leads to disruption of the blood supply to the kidney, which is already in a state of hypoperfusion. ACE inhibitors and angiotensin receptor blockers are not used for this pathology, since they can worsen kidney function. If necessary, calcium channel blockers and α-blockers are used as antihypertensive drugs.

Conservative treatment is carried out in elderly patients with systemic damage to the bloodstream. In case of atherosclerotic process, it is necessary to prescribe

Diseases of the urinary system affect approximately 35% of the entire world population. Approximately 25-30% are associated with kidney abnormalities. These include: renal artery aneurysms, multiple or double renal arteries, solitary artery, accessory renal artery, fibromuscular stenosis, etc.

Accessory renal artery - what is it?

Accessory renal artery is the most common malformation of renal vessels. This disease occurs in approximately 80% of cases in people suffering from kidney disease. An accessory artery is an artery that, along with the main renal artery, supplies blood to the kidney.

With this anomaly, two arteries depart from the kidneys: the main and the accessory. The accessory directs to the upper or lower segment of the kidney. The diameter of the accessory artery is smaller than the main one.

Causes

The anomaly occurs during embryonic development; the cause of such deviations is not known for certain. It is assumed that, for unknown reasons, there is a failure of normal development, as a result of which the renal artery may experience duplication.

Kinds

There are several types of pathologies of the renal vessels - arteries, depending on their number:

Double and multiple. Double accessory artery is rare. The second artery, as a rule, is reduced and is located in the pelvis in the form of branches on the left or right.
Multiple arteries are found in normal and pathological conditions. They depart in the form small vessels from the kidney.

Types of accessory renal artery

Clinical picture

The disease is usually asymptomatic. It appears only when the urinary tract is crossed by an accessory artery.

Due to this crossing, the outflow of urine from the kidneys becomes difficult, resulting in the following clinical manifestations:

Hydronephrosis - persistent and rapid expansion renal pelvis, which occurs due to a violation of the outflow of urine.
Arterial hypertension is high blood pressure (BP). A jump in blood pressure occurs due to a decrease in fluid content in the body, the vessels narrow, blood flow becomes more difficult, and as a result, pressure increases.
Kidney infarction. With prolonged hydronephrosis, gradual atrophy of the renal parenchyma occurs, which subsequently leads to infarction of the entire kidney.
Formation of blood clots and bleeding at the intersection of the accessory artery and the urinary tract.

The kidney increases in size. There may be blood in the urine, and going to the toilet becomes painful. Patients complain about aching pain in the lower back and high blood pressure.

On palpation it develops pain syndrome in the form of attacks renal colic, pain can also radiate to the ribs, as with physical activity, and at rest.

Diagnostics

Most often, double and multiple renal arteries are diagnosed. With this deviation, the blood supply to the kidney is provided by two or more channels of equivalent caliber. The disease is difficult to determine, since similar renal arteries are observed in a healthy kidney. They do not always organize pathology, but are often combined with other types of pathologies.

Availability Determination renal pathologies carried out using x-ray examination.

To determine special cases of anomalous renal arteries, use:

excretory;
Lower cavography;
Renal venography;
Aortography.

When a patient has a double or multiple renal artery, the resulting pyelograms make it possible to detect defects in the filling of the ureter, notice narrowings and kinks in the places where the vessel passes, and pyeloctasia.

To determine the anomaly of the solitary artery, aortography is used.

As common methods Minimally invasive techniques are widely used: ultrasound renal doppelography, MSCT, etc.

Treatment

What to do and how to carry out treatment is determined only after full diagnostics diseases. Treatment is based on restoring the physiologically normal flow of urine from the body. This effect can only be achieved through surgery.

Resection of the accessory artery. Removal can be complete or partial. Partial - the accessory artery and the damaged area are almost removed. Complete removal- removal of both the accessory artery and the entire kidney.

Resection urinary tract. This operation is performed when resection of the accessory artery is impossible. The narrowed section of the urinary tract is removed and stitched back together.

Way surgical intervention determined by a urologist-surgeon individually for each patient.

Narrowing of the lumen of the right or left renal artery is called stenosis. Bilateral damage is also possible. Clinical manifestations caused by ischemia renal tissue. The main signs are severe arterial hypertension and nephropathy. Used for treatment medicines, and surgical methods– plastic surgery, installation of a stent or shunt, removal inner shell arteries.

Read in this article

Why does stenosis of the right and left renal arteries occur, bilateral

The vast majority of patients (about 70%) have . It affects men over 50 years of age much more often than women. The typical location is a branch from the aorta. Background conditions preceding stenosis include ischemic disease and diabetes mellitus.

Congenital thickening of the layers of the arteries is diagnosed, as a rule, in women after 35 years of age. The place of narrowing in these cases is located in the middle segments. The enlargement may affect the inner or middle tunic of one, but more often both, renal arteries.

Less common causes include:

or ;
arteriovenous connection (developmental anomaly);
systemic vasculitis;
, emboloma;
pressure on the tumor vessel;
kidney prolapse.

Aortic aneurysm is one of the causes of renal artery stenosis

Lack of blood flow promotes activation of the renin-angiotensin-aldosterone system. This leads to persistent arterial hypertension.

Symptoms of the onset of the disease

When high blood pressure is first detected, it is always necessary to exclude it, including arterial origin. The main feature of such hypertension is usually high numbers of lower () pressure. It can increase to 140 - 160 mm Hg. Art. with a norm of 90. Renal hypertension rarely gives and has a weak response to.

At high blood pressure patients report the following symptoms:

pain in the back of the head, eyeballs, heaviness in the head;
hot flashes;
noise in ears;
sleep disturbance, irritability, increased fatigue;
flashing dots or spots before the eyes;
increased heart rate;
dyspnea;
cardialgia, pressure behind the sternum;
pulmonary edema with a recurrent course in severe pathology.

ethnoscience

Herbs can be recommended at the stage of compensation for stenosis, but most often they are used after surgery as part of a complex of rehabilitation measures. The advantages of this method of recovery are low toxicity, anti-inflammatory effect, prevention of congestion, mild stabilization of blood pressure.

Infusions or decoctions are prepared according to traditional recipes - a tablespoon per glass of boiling water. For infusion, keep in a sealed container for about 30 minutes, and for decoction, first keep on low heat for 10 - 15 minutes. With narrowing of the renal arteries
apply:

What to do if renal artery stenosis and arterial hypertension develop

This disease cannot be cured without using surgical methods renal revascularization. Independent restoration of arterial patency was also not recorded.

Therefore, the only hope for a cure is surgery. If it is not carried out in right time(until the kidney has lost function), then instead of the intravascular method of treatment, which can be carried out without hospitalization, removal of the kidney will be required. This is especially dangerous with bilateral lesions.

The most correct tactic is to contact a specialist if your blood pressure increases for in-depth diagnosis.

Prognosis for the patient

Depending on the cause of the stenosis, surgical treatment restores normal indicators blood pressure from 70% (with thickening of the artery membranes) to 50% (with atherosclerotic changes). After endovascular surgery, rehabilitation takes from 1 to 3 months, and with conventional abdominal surgery it can take up to six months.

In case of severe stenosis, especially of both the right and left renal arteries, without surgery, patients are doomed; there is a high risk of death from failure of the kidneys, heart, and acute vascular accidents.

Renal artery stenosis develops with congenital thickening of the wall or atherosclerotic lesions. The main manifestations are severe form of hypertension, resistant to drugs, nephropathy. Medications and folk remedies at the stage of moderate hypertension. In all other cases, only surgery can help - plastic surgery, bypass surgery or stenting, removal of the stenotic area.