ABSTRACT
Resumo Coarctação da aorta abdominal é uma causa rara de claudicação de membros inferiores e hipertensão refratária. O tratamento é complexo e exige conhecimento de diversas técnicas de reconstrução vascular. Apresentamos um caso de coarctação ao nível das artérias renais, seu tratamento e revisão da literatura. Paciente feminina, 65 anos, com hipertensão refratária desde os 35 anos, utilizando cinco medicações anti-hipertensivas em dose máxima. Pressão arterial média de 260/180mmHg e claudicação incapacitante (menos de 20 metros) bilateral. Angiotomografia computadorizada demonstrou coarctação de aorta justarrenal de 4 mm de maior diâmetro, calcificação circunferencial no local da estenose e tortuosidade da aorta infrarrenal. Foi submetida a tratamento híbrido, com ponte ilíaco-birrenal e implante de stent Advanta V12 no local da estenose. A paciente evoluiu satisfatoriamente e, 60 dias depois da cirurgia, apresentava-se com uma pressão arterial de 140/80mmHg, em uso de apenas duas medicações anti-hipertensivas e sem claudicação.
Abstract Coarctation of the abdominal aorta is a rare etiology of intermittent claudication and refractory hypertension. Treatment is complex and requires knowledge of several vascular reconstruction techniques. We report a case of aortic coarctation at the level of the renal arteries, describing its treatment and presenting a literature review. Female patient, 65 years old, with refractory hypertension since the age of 35, using five antihypertensive medications at maximum doses. Blood pressure was 260/180mmHg and she had disabling claudication (less than 20 meters). Computed tomography angiography showed a 4mm coarctation in the juxtarenal aorta, with circumferential calcification at the stenosis site, and tortuous infrarenal aorta. Hybrid repair was performed with an iliac-birenal bypass and implantation of an Advanta V12 stent at the stenosis site. The patient's postoperative course was satisfactory, she was free from claudication, and her blood pressure 60 days after surgery was 140/80mmHg, taking two antihypertensive medications.
Subject(s)
Humans , Female , Aged , Aortic Coarctation/surgery , Aortic Coarctation/complications , Aorta, Abdominal , Aortic Coarctation/diagnosis , Renal Artery , Stents , Angioplasty, Balloon , Hypertension, Renovascular/surgery , Hypertension, Renovascular/etiology , Intermittent Claudication/surgery , Intermittent Claudication/etiologyABSTRACT
Objetivo: Relatar o caso de uma paciente jovem portadora de Hipertensão Arterial Secundária à estenose da artéria renal, que evoluiu com perda renal em decorrência de necessidade de nefrectomia unilateral, enfatizado a importância do diagnóstico e da abordagem adequada desta patologia para o controle da pressão arterial e preservação da função renal. Método: Os dados foram obtidos através de entrevista com a paciente, análise de prontuário, laudos de técnicas diagnósticas, as quais a paciente foi submetida, entre julho e novembro de 2019, durante as consultas médicas e revisão bibliográfica. Conclusão: A nefrectomia unilateral mostrou-se eficaz no controle da hipertensão arterial, na melhora do desempenho renal, possibilitando a melhoria na qualidade de vida do indivíduo afetado
Objective: To report the case of a young patient with SAH secondary to renal artery stenosis, who developed renal loss due to the need for unilateral nephrectomy, emphasizing the importance of the diagnosis and the appropriate approach of this pathology for the control of blood pressure and preservation of renal function. Method: The data were obtained through interview with the patient, analysis of medical records, reports of diagnostic techniques, which the patient was submitted between July and November 2019, during medical consultations and literature review. Conclusion: Unilateral Nephrectomy proved to be effective in controlling arterial hypertension, improving renal performance and in the evolution of renal insufficiency that is difficult to control from the renovascular root, enabling improvement in the affected individual's quality of life
Subject(s)
Humans , Female , Adult , Hypertension/therapy , Hypertension, Renovascular , NephrectomyABSTRACT
Resumo Fundamento O treino de força tem efeitos benéficos em doenças renais, além de ajudar a melhorar a defesa antioxidante em animais saudáveis. Objetivo Verificar se o treino de força reduz o dano oxidativo ao coração e rim contralateral para cirurgia de indução de hipertensão renovascular, bem como avaliar as alterações na atividade das enzimas antioxidantes endógenas superóxido dismutase (SOD), catalase (CAT) e glutationa peroxidase (GPx). Métodos Dezoito ratos machos foram divididos em três grupos (n=6/grupo): placebo, hipertenso e hipertenso treinado. Os animais foram induzidos a hipertensão renovascular através da ligação da artéria renal esquerda. O treino de força foi iniciado quatro semanas após a indução da hipertensão renovascular, teve 12 semanas de duração e foi realizada a 70% de 1RM. Depois do período de treino, os animais foram submetidos a eutanásia e o rim esquerdo e o coração foram retirados para realizar a quantificação de peróxidos de hidrogênio, malondialdeído e grupos sulfidrílicos, que são marcadores de danos oxidativos. Além disso, foram medidas as atividades das enzimas antioxidantes superóxido dismutase, catalase e glutationa peroxidase. O nível de significância adotado foi de 5% (p < 0,05). Resultados Depois do treino de força, houve redução de danos oxidativos a lipídios e proteínas, como pode-se observar pela redução de peróxidos de hidrogênio e níveis sulfidrílicos totais, respectivamente. Além disso, houve um aumento nas atividades das enzimas antioxidantes superóxido dismutase, catalase e glutationa peroxidase. Conclusão O treino de força tem o potencial de reduzir danos oxidativos, aumentando a atividades de enzimas antioxidantes. (Arq Bras Cardiol. 2021; 116(1):4-11)
Abstract Background Strength training has beneficial effects on kidney disease, in addition to helping improve antioxidant defenses in healthy animals. Objective To verify if strength training reduces oxidative damage to the heart and contralateral kidney caused by the renovascular hypertension induction surgery, as well as to evaluate alterations in the activity of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) endogenous antioxidant enzymes. Methods Eighteen male rats were divided into three groups (n=6/group): sham, hypertensive, and trained hypertensive. The animals were induced to renovascular hypertension through left renal artery ligation. Strength training was initiated four weeks after the induction of renovascular hypertension, continued for a 12-weeks period, and was performed at 70% of 1RM. After the training period, the animals were euthanized and the right kidney and heart were removed for quantitation of hydroperoxides, malondialdehyde and sulfhydryl groups, which are markers of oxidative damage. In addition, the activity of SOD, CAT, and GPx antioxidant enzymes was also measured. The adopted significance level was 5% (p < 0.05). Results After strength training, a reduction in oxidative damage to lipids and proteins was observed, as could be seen by reducing hydroperoxides and total sulfhydryl levels, respectively. Furthermore, an increased activity of superoxide dismutase, catalase, and glutathione peroxidase antioxidant enzymes was observed. Conclusion Strength training is able to potentially reduce oxidative damage by increasing the activity of antioxidant enzymes. (Arq Bras Cardiol. 2021; 116(1):4-11)
Subject(s)
Humans , Animals , Male , Rats , Hypertension, Renovascular/metabolism , Catalase/metabolism , Rats, Wistar , Oxidative Stress , Resistance Training , Kidney , Antioxidants/metabolismSubject(s)
Humans , Animals , Rats , Resistance Training , Hypertension, Renovascular , Oxygen Consumption , Oxidative Stress , HeartABSTRACT
30 to 40% of the adult population worldwide has been diagnosed with hypertension, among these patients 5 to 10% of them could have a possibly curable condition. In order to recognize this special population, the clinician must perform a complete work up and be aware of the main underlying causes of secondary hypertension. Often this could be a goal difficult to accomplish. The purpose of this article is to discuss the most frequent causes of secondary hypertension and offer a diagnostic approach for these patients. Clinicians should never forget that drug-related hypertension is a common cause that is discovered only with the help of a good medical history.
Subject(s)
Humans , Hypertension/prevention & control , Hypertension, Renovascular/etiology , Pheochromocytoma , Sleep Apnea Syndromes , Blood Pressure Monitoring, Ambulatory , Hyperaldosteronism , Hypertension/diagnosis , Hypertension/etiology , Hypertension, Renovascular/diagnosis , Antihypertensive Agents/therapeutic useABSTRACT
Abstract Background: Arterial hypertension is a precursor to the development of heart and renal failure, furthermore is associated with elevated oxidative markers. Environmental enrichment of rodents increases performance in memory tasks, also appears to exert an antioxidant effect in the hippocampus of normotensive rats. Objectives: Evaluate the effect of environmental enrichment on oxidative stress in the ventrolateral medulla, heart, and kidneys of renovascular hypertensive rats. Methods: Forty male Fischer rats (6 weeks old) were divided into four groups: normotensive standard condition (Sham-St), normotensive enriched environment (Sham-EE), hypertensive standard condition (2K1C-St), and hypertensive enriched environment (2K1C-EE). Animals were kept in enriched or standard cages for four weeks after all animals were euthanized. The level of significance was at p < 0.05. Results: 2K1C-St group presented higher mean arterial pressure (mmHg) 147.0 (122.0; 187.0) compared to Sham-St 101.0 (94.0; 109.0) and Sham-EE 106.0 (90.8; 117.8). Ventrolateral medulla from 2K1C-EE had higher superoxide dismutase (SOD) (49.1 ± 7.9 U/mg ptn) and catalase activity (0.8 ± 0.4 U/mg ptn) compared to SOD (24.1 ± 9.8 U/mg ptn) and catalase activity (0.3 ± 0.1 U/mg ptn) in 2K1C-St. 2K1C-EE presented lower lipid oxidation (0.39 ± 0.06 nmol/mg ptn) than 2K1C-St (0.53 ± 0.22 nmol/mg ptn) in ventrolateral medulla. Furthermore, the kidneys of 2K1C-EE (11.9 ± 2.3 U/mg ptn) animals presented higher superoxide-dismutase activity than those of 2K1C-St animals (9.1 ± 2.3 U/mg ptn). Conclusion: Environmental enrichment induced an antioxidant effect in the ventrolateral medulla and kidneys that contributes to reducing oxidative damage among hypertensive rats.
Resumo Fundamento: A hipertensão arterial é um precursor para o desenvolvimento da insuficiência cardíaca e renal e, além disso, está associada com o aumento dos marcadores oxidativos. O enriquecimento ambiental dos roedores melhora o desempenho em tarefas de memória, e também parece ter um efeito antioxidante sobre o hipocampo dos ratos normotensos. Objetivos: Avaliar o efeito do enriquecimento ambiental sobre o estresse oxidativo no bulbo ventrolateral, coração, e rins de ratos com hipertensão renovascular. Métodos: Quarenta ratos machos, tipo Fischer (6 semanas de idade), foram divididos em quatro grupos: normotensos em condições padrão (Sham-CP), normotensos em ambiente enriquecido (Sham-AE), hipertensos em condições padrão (2R1C-CP), e hipertensos em ambiente enriquecido (2R1C-AE). Os animais foram mantidos em gaiolas enriquecidas ou padrão durante quatro semanas e, por fim, todos os animais foram eutanasiados. O nível de significância foi p < 0,05. Resultados: O grupo 2R1C-CP apresentou pressão arterial média maior (mmHg) 147,0 (122,0; 187,0) quando comparado com os grupos Sham-CP 101,0 (94,0; 109,0) e Sham-AE 106,0 (90,8; 117,8). Observou-se maior atividade das enzimas superóxido dismutase (SOD) (49,1 ± 7,9 U/mg ptn) e da catalase (0,8 ± 0,4 U/mg ptn) no bulbo ventrolateral do grupo 2R1C-AE, em relação à atividade da SOD (24,1 ± 9,8 U/mg ptn) e da catalase (0,3 ± 0,1 U/mg ptn) no grupo 2R1C-CP. No grupo 2R1C-AE, a oxidação lipídica no bulbo ventrolateral foi menor (0,39 ± 0,06 nmol/mg ptn) quando comparado com o grupo 2R1C-CP (0,53 ± 0,22 nmol/mg ptn). Ademais, foi observada maior atividade das enzimas superóxido dismutase nos rins dos animais 2R1C-AE (11,9 ± 2,3 U/mg ptn) em relação aos animais 2R1C-CP (9,1 ± 2,3 U/mg ptn). Conclusão: O enriquecimento ambiental provocou efeito antioxidante no bulbo ventrolateral e nos rins, o que contribuiu para a redução do dano oxidante nos ratos hipertensos.
Subject(s)
Animals , Male , Medulla Oblongata/metabolism , Oxidative Stress , Environment , Housing, Animal , Hypertension, Renovascular/metabolism , Antioxidants/metabolism , Rats, Inbred F344 , Superoxide Dismutase/metabolism , Medulla Oblongata/enzymology , Lipid Peroxidation , Catalase/metabolism , Protein Carbonylation , Arterial Pressure , Heart Ventricles/enzymology , Hypertension, Renovascular/chemically induced , Kidney/enzymologyABSTRACT
BACKGROUND@#Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP). However, few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP. Thus, this study will aim to evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) for assessing both RAS and RMP to achieve a one-stop assessment of patients with suspected renovascular hypertension.@*METHODS@#This will be a single-center diagnostic study with a sample size of 440. Patients with chronic kidney disease (CKD) and suspected of having resistant hypertension will be eligible. Patients with Stages 1-3 CKD will undergo CEUS and computed tomography (CT) angiography (CTA). Values obtained by CEUS and CTA for diagnosing low-grade (lumen reduced by <60%) and high-grade (lumen reduced by ≥60%) RAS will be compared. Moreover, all patients will also undergo radionuclide imaging. The diagnostic value for RAS will be assessed by the receiver operating characteristic curve, including the accuracy, sensitivity, specificity, positive predictive values, negative predictive values, and area under the ROC. Pearson correlation analysis will be performed to assess the association between CEUS findings for RMP and glomerular filtration rate measured by a radionuclide imaging method.@*CONCLUSION@#The data gathered from this study will be used to evaluate the feasibility of expanding clinical applications of CEUS for evaluation of patients with suspected renovascular hypertension.@*TRIAL REGISTRATION@#Chinese Clinical Trial Registry, ChiCTR1800016252; https://www.chictr.org.cn.
Subject(s)
Humans , Contrast Media , Glomerular Filtration Rate , Physiology , Hypertension, Renovascular , ROC Curve , Renal Artery , Renal Artery ObstructionABSTRACT
PURPOSE: This study aimed to determine the diagnostic value of the relative filtration fraction (RFF) assessed by dynamic ⁹⁹mTc-diethylenetriaminepentaacetic acid (⁹⁹mTc-DTPA) renal scintigraphy after angiotensin-converting enzyme (ACE) inhibition for renovascular hypertension (RVHT) diagnosis.METHODS: ⁹⁹mTc-DTPA captopril renal scintigraphy performed in adolescents or adults (≥ 10 years) with suspected RVHT was retrospectively reviewed. The RFF of the affected kidney was qualitatively assessed as the relative glomerular filtration rate during the 2 to 3-min period compared with the relative perfusion during the first 60 s (qualitative RFF) and scored from 1 (definitely same) to 5 (definitely decreased). The quantitative RFF of the affected kidney was obtained by dividing the percentage of glomerular filtration rate by the percentage of renal perfusion.RESULTS: Overall, 173 patients (high probability, n = 15; and low probability, n = 158) were included based on conventional captopril renal scintigraphic criteria. An abnormal qualitative RFF was observed in 12 patients with high probability, and the diagnostic sensitivity was 80.0% (95% CI, 51.9–95.7). The RFF was normal in 152 patients with low probability, and the diagnostic specificity was 96.2% (95% CI, 91.9–98.6). The RFF was lower in patients with high probability than in those with low probability (0.79 ± 0.15 vs. 1.02 ± 0.11, P < 0.0001).CONCLUSIONS: The RFF assessed by dynamic ⁹⁹mTc-DTPA renal scintigraphy after ACE inhibition can detect patients with high probability for RVHT. The RFF after ACE inhibition might be a useful diagnostic criterion especially when baseline scintigraphy is not available for evaluating ACE inhibition-induced changes.
Subject(s)
Adolescent , Adult , Humans , Captopril , Diagnosis , Filtration , Glomerular Filtration Rate , Hypertension, Renovascular , Kidney , Perfusion , Radionuclide Imaging , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Abstract The tubular hypotrophy of the renal arteries constitutes a rare clinical entity, that is associated with the appearance of renovascular hypertension. Its diagnostic approach is complex and requires the availability of angiography to determine the features of the renal vessels. The following case exemplifies the diagnostic process of a patient with this special clinical situation.
Resumen La hipotrofia de aspecto tubular de las arterias renales constituye una rara entidad clínica asociada a la aparición de hipertensión renovascular. Su enfoque diagnóstico es complejo y exige la disponibilidad de angiografía para determinar las características propias del contorno de la vasculature renal. El caso clínico considerado en este artículo ejemplifica el proceso diagnóstico de un paciente con esta particular situación.
Subject(s)
Humans , Male , Female , Adult , Renal Artery , Anemia, Hypoplastic, Congenital , Hypertension, Renovascular , Colombia , Acute Kidney InjuryABSTRACT
Concurrent involvement of bilateral renal and cerebral arteries, usually incurred as stenosis, is rare in childhood-onset Takayasu arteritis (c-TA). We report the case of a 14-year-old girl, with c-TA, presenting with transient ischemic attack after endovascular revascularization for renal artery stenosis and cerebrovascular stroke after surgical revascularization for cerebral artery stenosis associated with childhood-onset moyamoya syndrome. We deem that decrease of blood pressure by endovascular revascularization and improvement of cerebral perfusion by surgical revascularization may have jeopardized the cerebral deep watershed zone to cerebral ischemia followed by cerebral hyperperfusion syndrome and caused transient ischemic attack and cerebrovascular stroke in our patient. Revascularization could be a double-edge sword for c-TA patients presenting with concomitant renal artery stenosis and cerebral artery stenosis, and should be performed with caution. Quantitative analysis of cerebral blood flow by brain magnetic resonance imaging and angiography should be performed within 48 hours after surgical revascularization in c-TA.
Subject(s)
Adolescent , Female , Humans , Angiography , Blood Pressure , Brain , Brain Ischemia , Cerebral Arteries , Cerebrovascular Circulation , Constriction, Pathologic , Hypertension, Renovascular , Ischemic Attack, Transient , Magnetic Resonance Imaging , Moyamoya Disease , Perfusion , Renal Artery Obstruction , Stroke , Takayasu ArteritisABSTRACT
Trypanosoma cruzi triggers a progressive inflammatory response affecting cardiovascular functions in humans and experimental models. Angiotensin II, a key effector of the renin-angiotensin system, plays roles in mediating hypertension, heart failure, and inflammatory responses. T. cruzi and AngII can induce inflammatory responses by releasing inflammatory mediators. The aim of this study was to evaluate systemic AngII, tumor necrosis factor (TNF), and CX3CL1 mediators in a two-kidney one-clip (2K1C) renovascular hypertension model using Wistar rats infected with T. cruzi. Our data showed an increase in serum AngII in uninfected and T. cruzi-infected rats 1 week after 2K1C surgery compared to non-2K1C (Sham) animals. The baseline systolic blood pressure was higher in both uninfected and infected 2K1C rats. Despite no difference in circulating parasites in the acute phase of infection, elevated serum TNF and CX3CL1 were observed at 8 weeks post-infection in 2K1C rats in association with higher cardiac inflammatory infiltration. In summary, AngII-induced hypertension associated with T. cruzi infection may act synergistically to increase TNF and CX3CL1 in the 2K1C rat model, thereby intensifying cardiac inflammatory infiltration and worsening the underlying inflammation triggered by this protozoan.
Subject(s)
Animals , Male , Rats , Chagas Disease/blood , Chemokine CX3CL1/blood , Hypertension, Renovascular/blood , Tumor Necrosis Factor-alpha/blood , Biomarkers/blood , Chagas Disease/complications , Disease Models, Animal , Hypertension, Renovascular/parasitology , Rats, WistarABSTRACT
Posterior reversible encephalopathy syndrome (PRES, or posterior leukoencephalopahty syndrome) is a neurological condition caused by reversible cortical/subcortical vasogenic brain edema secondary to hypertension, cytotoxic drugs, immunosuppressants, autoimmune diseases, renal disease, eclampsia or pre-eclampsia. It is characterized by acute neurological symptoms such as headache, seizures, visual disturbances, and impaired levels of consciousness. Brain imaging usually reveals bilateral, cortical/subcortical vasogenic edema. Completely unilateral PRES constituted only 2.6% of the cases in a previous study. Here we report the case of a pediatric patient with completely unilateral PRES. A 13-year-old boy was admitted with acute gastroenteritis. On the fourth day of hospitalization, he started to complain of headache and vomiting. He then developed generalized tonic-clonic seizure 3 times. His blood pressure was 180/121 mmHg during the first seizure, 188/112 mmHg during the second seizure and 152/92 mmHg during the third seizure. T2-weighted imaging with fluid attenuation by inversion recovery (T2 FLAIR) demonstrated high-signal intensity in the cortical gyri of the left frontal, parietal, and occipital lobes. Follow-up magnetic resonance imaging (MRI) was performed 2 weeks after the seizure onset, which indicated a significant improvement in the patient's condition. Abdominal pelvic computed tomography (CT) and renal CT angiography showed abnormal narrowing of the left renal artery. In summary, we present a case report of unilateral PRES secondary to renovascular hypertension due to left renal arterial obstruction.
Subject(s)
Adolescent , Female , Humans , Male , Pregnancy , Angiography , Autoimmune Diseases , Blood Pressure , Brain Edema , Consciousness , Eclampsia , Edema , Follow-Up Studies , Gastroenteritis , Headache , Hospitalization , Hypertension , Hypertension, Renovascular , Immunosuppressive Agents , Magnetic Resonance Imaging , Neuroimaging , Occipital Lobe , Posterior Leukoencephalopathy Syndrome , Pre-Eclampsia , Rabeprazole , Renal Artery Obstruction , Renal Artery , Seizures , VomitingABSTRACT
OBJECTIVE: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63±12 vs 56±12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial index <0.9 (44% vs 20%, p=0.021) than patients without severe renal artery stenosis. Multivariate logistic regression analysis showed that the presence of intermittent claudication was independently associated with renal artery stenosis ≥70% (OR: 3.33; 95% CI 1.03-10.82, p=0.04), unlike the ankle-brachial index, which showed no association (OR: 1.44; 95% CI 0.37-5.66, p=0.60). CONCLUSION: Intermittent claudication is independently associated with severe renal artery stenosis (≥70%) in patients clinically suspected of having renovascular hypertension.
Subject(s)
Humans , Male , Female , Middle Aged , Hypertension, Renovascular/complications , Intermittent Claudication/complications , Renal Artery Obstruction/complications , Renal Artery/diagnostic imaging , Angiography , Hypertension, Renovascular/diagnostic imaging , Intermittent Claudication/diagnostic imaging , Radionuclide Imaging , Renal Artery Obstruction/diagnostic imaging , Severity of Illness Index , Ultrasonography, DopplerABSTRACT
A doença renovascular aterosclerótica é a principal causa de hipertensão secundária. A história natural da doença demonstra taxas de progressão de 4 a 12% ao ano. Entre os métodos de tratamento existe a angioplastia com stent de artérias renais; porém, poucos estudos clínicos demonstraram seus resultados a longo prazo. Esta revisão sistemática da literatura se propõe a apresentar os resultados a longo prazo (acima de 24 meses) da angioplastia com stent de artérias renais na doença aterosclerótica em relação à função renal e aos níveis pressóricos no controle da hipertensão. Foi realizada uma ampla pesquisa, utilizando os termos apropriados, nas bases de dados LILACS, EMBASE, SCIELO, Cochrane Library e MEDLINE. De um total de 2.170 referências, apenas sete artigos contemplavam todos os critérios de inclusão. Conclui-se que, a longo prazo, há uma estabilização da função renal, redução dos níveis pressóricos e diminuição do número de classes de medicamentos anti-hipertensivos
Atherosclerotic renovascular disease is the most important cause of secondary hypertension. The natural history of the disease reveals progression rates of 4 to 12% per year. Angioplasty with renal artery stenting is one treatment option; but there are few studies that have reported long-term results. The objective of this systematic literature review is to discuss the long-term results (at least 24 months) of angioplasty with stenting of renal arteries for atherosclerotic disease, in terms of renal function and blood pressure levels for control of hypertension. A thorough search was conducted of LILACS, EMBASE, SCIELO, Cochrane Library, and MEDLINE using the appropriate terms. Just seven out of 2170 references identified met all inclusion criteria. It was concluded that over the long term renal function was stabilized, blood pressure levels were reduced, and the number of classes of antihypertensive medication decreased
Subject(s)
Humans , Male , Female , Aged , Angioplasty/methods , Atherosclerosis/diagnosis , Atherosclerosis/therapy , Renal Artery Obstruction/diagnosis , Renal Artery Obstruction/therapy , Stents , Treatment Outcome , Antihypertensive Agents/therapeutic use , Database , Hypertension, Renovascular/diagnosis , Hypertension, Renovascular/therapy , Kidney Diseases/diagnosis , Kidney Diseases/therapy , Renal Artery , Sex FactorsABSTRACT
Abstract Patients with vascular diseases present with a long medical history which makes for complex and confusing medical records. Electronic record systems have a large storage capacity and high information processing capabilities, and may therefore improve the quality and reliability of prospective clinical studies. In the present study, a theoretical framework for clinical data collection in chronic visceral ischemia was created containing 5706 items, organized into six major categories: medical history, physical examination, laboratory testing, diagnosis, treatment and outcome. The database was used to construct an electronic data collection protocol, which was uploaded into the Integrated Electronic Protocol System (Sistema Integrado de Protocolos Eletrônicos, SINPE©) and then used to perform retrospective collection and analysis of clinical data from 10 patients using the SINPE© analysis module.
Resumo Pacientes portadores de doenças vasculares possuem histórico médico longo, o que dificulta a revisão das informações contidas nos prontuários. Protocolos eletrônicos de dados clínicos permitem grande capacidade de armazenamento e processamento de informações, otimizando a qualidade e a confiabilidade de trabalhos científicos. Neste trabalho foi criada uma base teórica para coleta de dados clínicos referentes à isquemia crônica visceral composta de 5.706 itens agrupadas sob os seguintes categorias principais: anamnese, exame físico, exames complementares, diagnóstico, tratamento e evolução. Essa base foi transformada em um protocolo eletrônico de coleta de dados, e este foi incorporado ao Sistema Integrado de Protocolos Eletrônicos (SINPE©) e utilizado para cadastrar, coletar e analisar os dados de dez pacientes através do módulo SINPE© Analisador.
Subject(s)
Humans , Data Collection , Hypertension, Renovascular , Hypertension/complications , Mesenteric Ischemia , Guidelines as Topic , Chronic Disease , Database , Electronic Health Records/trends , Renal ArteryABSTRACT
A estenose da artéria renal (EAR) é uma importante causa de hipertensão arterial sistêmica (HAS) secundária e disfunção renal. O principal mecanismo é por doença aterosclerótica unilateral ou bilateral. O diagnóstico precoce é importante para se evitar falência renal terminal e graves complicações cardiovasculares. O início de HAS precoce ou tardia, sopros abdominais, déficit renal sem causa aparente e HAS resistente são achados clínicos para se suspeitar de EAR, sendo necessários exames complementares como o Doppler colorido, angiotomografia ou ressonância nuclear magnética das artérias renais. A arteriografia renal é o padrão ouro para confirmação diagnóstica. O tratamento medicamentoso está indicado para os pacientes assintomáticos ou que mantêm controle clínico satisfatórios. A intervenção percutânea da artéria renal com uso de stents tem sido motivo de controvérsia, ficando restrita aos pacientes com perda progressiva da função renal e estenose bilateral, hipertensão arterial resistente ao tratamento medicamentoso, edema agudo de pulmão hipertensivo de repetição e disfunção de enxerto renal no caso de pacientes submetidos ao transplante renal
Renal artery stenosis (RAS) is an important cause of secondary systemic hypertension and renal dysfunction. The main mechanism is unilateral or bilateral atherosclerotic disease. Early diagnosis is important to avoid terminal renal failure and severe cardiovascular complications. The onset of early or late secondary systemic hypertension, abdominal murmurs, renal failure without apparent cause, and resistant secondary systemic hypertension are clinical findings to suspect RAS, and complementary exams such as color Doppler, angiotomography or magnetic nuclear magnetic resonance imaging of the renal arteries are necessary. Renal arteriography is the gold standard for diagnostic confirmation. Drug treatment is indicated for patients who are asymptomatic or who maintain satisfactory clinical control. Percutaneous renal artery intervention with stents has been controversial, being restricted to patients with progressive renal function loss and bilateral stenosis, drug-resistant hypertension, acute repetitive hypertensive pulmonary edema and renal graft dysfunction in patients submitted to kidney transplant
Subject(s)
Humans , Male , Female , Renal Artery Obstruction/etiology , Renal Artery Obstruction/mortality , Clinical Diagnosis , Atherosclerosis/etiology , Hypertension, Renovascular/physiopathology , Therapeutics/methods , Angiography/methods , Radionuclide Imaging/methods , Stents , Survival Rate , Angioplasty/methodsABSTRACT
Pediatric vascular disease is rare, and remains a big challenge to vascular surgeons. In contrast to adults, surgery for pediatric vascular disease is complicated by issues related to small size, future growth, and availability of suitable vascular conduit. During the last 30 years, 131 major vascular operations were performed in a tertiary referral center, Seoul National University Hospital, including aortoiliac aneurysm, acute or chronic arterial occlusion, renovascular hypertension, portal venous hypertension, trauma, tumor invasion to major abdominal vessels, and others. Herein we review on the important pediatric vascular diseases and share our clinical experiences on these rare diseases.
Subject(s)
Adult , Child , Humans , Aneurysm , Aortic Aneurysm , Hypertension , Hypertension, Portal , Hypertension, Renovascular , Rare Diseases , Seoul , Surgeons , Tertiary Care Centers , Thrombectomy , Transplantation, Autologous , Vascular DiseasesABSTRACT
Abstract Background: Labdane-type diterpenes induce lower blood pressure via relaxation of vascular smooth muscle; however, there are no studies describing the effects of labdanes in hypertensive rats. Objective: The present study was designed to investigate the cardiovascular actions of the labdane-type diterpene ent-3-acetoxy-labda-8(17), 13-dien-15-oic acid (labda-15-oic acid) in two-kidney 1 clip (2K-1C) renal hypertension. Methods: Vascular reactivity experiments were performed in aortic rings isolated from 2K-1C and normotensive (2K) male Wistar rats. Nitrate/nitrite (NOx) measurement was performed in aortas by colorimetric assay. Blood pressure measurements were performed in conscious rats. Results: Labda-15-oic acid (0.1-300 µmol/l) and forskolin (0.1 nmol/l - 1 µmol/l) relaxed endothelium-intact and endothelium-denuded aortas from both 2K-1C and 2K rats. Labda-15-oic acid was more effective at inducing relaxation in endothelium-intact aortas from 2K pre-contracted with phenylephrine when compared to the endothelium-denuded ones. Forskolin was more potent than labda-15-oic acid at inducing vascular relaxation in arteries from both 2K and 2K-1C rats. Labda-15-oic acid-induced increase in NOx levels was lower in arteries from 2K-1C rats when compared to 2K rats. Intravenous administration of labda-15-oic acid (0.3-3 mg/kg) or forskolin (0.1-1 mg/kg) induced hypotension in conscious 2K-1C and 2K rats. Conclusion: The present findings show that labda-15-oic acid induces vascular relaxation and hypotension in hypertensive rats.
Resumo Fundamento: Diterpenos do tipo labdano induzem uma queda da pressão arterial por meio do relaxamento do músculo liso vascular; todavia, não há estudos que descrevam os efeitos de labdanos em ratos hipertensos. Objetivo: O presente estudo foi desenvolvido para investigar as ações cardiovasculares do labdano ácido ent-3-acetóxi-labda-8(17),13-dieno-15-óico (labda-15-óico) na hipertensão renal dois rins-1 clipe (2R-1C). Métodos: Foram feitos experimentos de reatividade vascular em anéis aórticos isolados de ratos machos 2R-1C e normotensos (2R). A medição de Nitrato/Nitrito (NOx) foi feita nas aortas por meio de ensaio colorimétrico. As medidas de pressão arterial foram feitas em ratos conscientes. Resultados: O ácido labda-15-óico (0,1 - 300 µmol/l) e a forscolina (0,1 nmol/l - 1 µmol/l) relaxaram as aortas com endotélio intacto e as aortas sem endotélio dos ratos 2R-1C e 2R. O labda-15-óico mostrou-se mais eficaz na indução do relaxamento em aortas com endotélio intacto de 2R pré-contraídas com fenilefrina em comparação àquelas sem endotélio. A forscolina mostrou-se mais potente do que o ácido labda-15-óico na indução do relaxamento vascular nas artérias tanto de ratos 2R-1C quanto de ratos 2R. O aumento dos níveis de NOx induzido pelo ácido labda-15-óico foi menor nas artérias de ratos 2R-1C em comparação a ratos 2R. A administração intravenosa de ácido labda-15-óico (0,3-3 mg/kg) ou forscolina (0,1-1 mg/kg) induziu hipertensão em ratos 2R-1C e 2R conscientes. Conclusão: Os presentes resultados mostram que o labda-15-óico induz relaxamento vascular e hipotensão em ratos hipertensos.
Subject(s)
Animals , Male , Rats , Vasodilator Agents/pharmacology , Blood Pressure/drug effects , Colforsin/pharmacology , Diterpenes/pharmacology , Hypertension, Renovascular/drug therapy , Aorta, Thoracic/drug effects , Phenylephrine/antagonists & inhibitors , Vasoconstrictor Agents/antagonists & inhibitors , Vasodilation/drug effects , Vasodilator Agents/chemistry , Colforsin/chemistry , Rats, Wistar , Disease Models, Animal , Diterpenes/chemistry , Drug Evaluation, Preclinical , Hypertension, Renovascular/physiopathology , Muscle, Smooth, Vascular/drug effects , Nitric Oxide/analysisABSTRACT
Midaortic syndrome (MAS) is a rare vascular disease that commonly causes renovascular hypertension. The lumen of the abdominal aorta narrows and the ostia of the branches show stenosis. MAS is associated with diminished pulses in the lower extremities compared with the upper extremities, severe hypertension with higher blood pressure in the upper rather than lower extremities, and an abdominal bruit. The clinical symptoms are variable, and recognition in children with hypertension can aid early diagnosis and optimal treatment. Hypertension with MAS is malignant and often refractory to several antihypertensive drugs. Recently, radiologic modalities have been developed and have led to numerous interventional procedures. We describe the case of a 3-year-old boy presenting with left ventricular hypertrophy whose severely elevated blood pressure led to the diagnosis of idiopathic MAS. This case highlights the importance of measuring blood pressure and conducting a detailed physical examination to diagnose MAS. This is the first reported case of idiopathic MAS diagnosed in childhood in Korea.