ABSTRACT
Problems of the surgical treatment of vasorenal hypertension in children are elucidated as well as types of reconstruction of the renal arteries, indications and contra-indications for surgery. Results of 34 operations fulfilled for fibromuscular lesions of the renal arteries in 32 patients and causes of reoperations and resection of the organs are analyzed.
Subject(s)
Arterial Occlusive Diseases/surgery , Fibromuscular Dysplasia/surgery , Hypertension, Renovascular/surgery , Renal Artery Obstruction/surgery , Renal Artery/surgery , Adolescent , Aorta, Abdominal/surgery , Blood Vessel Prosthesis , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Nephrectomy/methods , Replantation/methods , Veins/transplantationSubject(s)
Aortitis/complications , Arteritis/complications , Hypertension, Renal/etiology , Hypertension, Renovascular/etiology , Adolescent , Aortitis/surgery , Arteritis/surgery , Child , Child, Preschool , Female , Humans , Hypertension, Renovascular/surgery , Male , Nephrectomy , Renal Artery Obstruction/complications , Renal Artery Obstruction/surgeryABSTRACT
Ultrastructural examinations of 32 cases of various forms of fibrousmuscular dysplasia (FMD) of renal arteries showed the lesions at the subcellular level to be identical in all these forms and to differ only in their intensity and localization. As the disease progresses, smooth muscle cells (SMC) show signs of activation accompanied by an increased collagen synthesis. In this, the cells exhibit large multiblade nuclei, intensive proliferation of the granular endoplasmic reticulum, hypertrophy of the Golgi complex. In cases of intensive fibrous changes, occasional fibroblasts appear in the arterial media. As collagen accumulates in intercellular spaces, signs of involution of various degrees are found in SMC. The number of elastic fibers in the media of the affected arteries decreases markedly as compared with the control. The inner elastic membrane of the arteries is frequently destroyed, particularly in the intimal form of the lesions. The study suggests that all forms of FMD represent a single process in the morphogenesis of which the leading role is played by fibroblast-like transformation of SMC.
Subject(s)
Arterial Occlusive Diseases/pathology , Fibromuscular Dysplasia/pathology , Renal Artery/ultrastructure , Adolescent , Adult , Chronic Disease , Female , Humans , Hypertension, Renovascular/pathology , Middle Aged , Muscle, Smooth/ultrastructure , Renal Artery Obstruction/pathologyABSTRACT
Thirty-two cases of fibrous-muscular dysplasial of renal arteries (including one autopsy case) were studied. Sections of renal arteries removed at reconstructive operations from patients suffering from renovascular hypertension were examined. Two morphological variants of the process were distinguished: medial dysplasia (perimedial fibroplasia, medial fibroplasia, and dissecting aneurysm) and intimal proliferation. Morphologically, fibrous-muscular dysplasia is a manifestation of proliferation of smooth muscle cell which appears to have various forms and stages. Diagnostically, fibrous-muscular dysplasia should be differentiated from atherosclerosis, nonspecific arteritis, proliferation of the intima due to hypovolemia, and perivascular sclerosis of different etiologies.
Subject(s)
Renal Artery Obstruction/pathology , Aneurysm/etiology , Humans , Hypertension, Renal/etiology , Muscle, Smooth/pathology , Renal Artery/pathology , Renal Artery Obstruction/etiologyABSTRACT
The examination was conducted in 72 patients with renovascular hypertension caused by fibromuscle dysplasia of the renal arteries. According to the authors, fibromuscle dysplasia of the renal arteries stands third after atherosclerosis and non-specific aorto-arteritis. Among the preliminary diagnostic measures of importance are such as intravenous urography, isotope renography, scintigraphy, but their value is much lower than in cases of atherosclerotic stenosis or stenosis due to non-specific aorto-arteritis, which is attributed to a good collateral circulation in the kidney. The diagnosis is made on the basis of serial angiography data. Of importance is also the method of selective renal angiography with functional tests with acetylcholoine and adrenalin. To characterize the form of renal artery pathology, three types of stenosis are distinguished: monofocal, multifocal, tubular. The terminology and classification are discussed, and a new term is suggested: "fibrous dysplasia of renal arteries".
Subject(s)
Arteriovenous Malformations , Renal Artery Obstruction , Renal Artery/abnormalities , Adolescent , Adult , Age Factors , Arteriovenous Malformations/classification , Arteriovenous Malformations/diagnosis , Child , Female , Humans , Male , Middle Aged , Renal Artery Obstruction/classification , Renal Artery Obstruction/diagnosis , Sex Ratio , Terminology as TopicABSTRACT
From among child-patients examined by the authors 41 were found to suffer from hypertension of vaso-renal genesis (58.5%). Major diagnostic tests were: functional intravenous urography, radioisotope renography, scintigraphy, angiography of the kidneys and also determination of the renin activity in the venous renal blood. The sole effective method of treating patients with vaso-renal hypertension is surgery.
