Renovascular Disease Flashcards
With what conditions may one suspect renal artery stenosis
HTN, recurrent pulmonary edema, ischemic nephropathy
When does renovascular HTN occur in renal artery stenosis
when stenosis exceed 70%
Where do the changes in renal artery stenosis occur causing HTN
level of the juxtaglomerular apparatus
How is HTN caused in renal artery stenosis
excessive secretion of renin
When is flash pulmonary edema seen in patients with renal artery stenosis
bilateral stenosis or severe stenosis in a solitary kidney
Which renal artery stenosis lesions should be treated
high grade (greater than 80% stenosis), rapidly progression on serial duplex, or greater than 60% stenosis in a solitary kidney
What is the best medical therapy for renal artery stenosis
combination therapy: ACE, ARB, CCB, b-blockers; statins and antiplatelet agents
When is balloon angioplasty indicated in renal artery stenosis
stenoses in the mid and distal renal artery
When is stenting indicated in renal artery stenosis
for proximal lesions
What are the 3 types of surgeries for renal artery stenosis
anatomic bypass, extra-anatomic bypass and nephrectomy
What does an anatomic bypass entail for renal artery stenosis
arise from the aorta or renal bypass graft and include thromboendarterectomy and renal artery reimplantation
For high risk patients with renal artery stenosis extra-anatomic bypasses are used, what are they
hepatorenal, splenorenal, iliorenal, mesorenal
When is a nephrectomy performed for renal artery stenosis
atrophic kidney, those less than 8cm in length, kidney without any excretory function (less than10% on radionuclide renography) and an occluded artery
