| 词条 | Renal artery stenosis |
| 释义 |
| name = Renal artery stenosis | synonyms = | image = Kidney PioM.png | caption = {{Div col|style=text-align:left; font-size:smaller}}{{unbulleted list|1. Renal pyramid | 2. Interlobular artery | 3. Renal artery | 4. Renal vein | 5. Renal hilum | 6. Renal pelvis | 7. Ureter | 8. Minor calyx | 9. Renal capsule | 10. Inferior renal capsule | 11. Superior renal capsule | 12. Interlobar vein | 13. Nephron | 14. Renal sinus | 15. Major calyx | 16. Renal papilla | 17. Renal column}}{{Div col end}} | pronounce = | field = | | symptoms = | complications = | onset = | duration = | types = | causes = | risks = Smoking, High blood pressure[1] | diagnosis = Captopril challenge test, Doppler ultrasound[2][3] | differential = | prevention = | treatment = ACE inhibitors[1] | medication = | prognosis = | frequency = | deaths = }}Renal artery stenosis is the narrowing of one of the renal arteries, most often caused by atherosclerosis or fibromuscular dysplasia. This narrowing of the renal artery can impede blood flow to the target kidney, resulting in renovascular hypertension – a secondary type of high blood pressure. Possible complications of renal artery stenosis are chronic kidney disease and coronary artery disease.[1] Signs and symptomsMost cases of renal artery stenosis are asymptomatic, and the main problem is high blood pressure that cannot be controlled with medication.[2] Decreased kidney function may develop if both kidneys do not receive adequate blood flow, furthermore some people with renal artery stenosis present with episodes of flash pulmonary edema.[3] CauseRenal artery stenosis is most often caused by atherosclerosis which causes the renal arteries to harden and narrow due to the build-up of plaque. This is known as atherosclerotic renovascular disease.{{citation needed|date=April 2018}}This accounts for about 90% of cases with most of the rest due to fibromuscular dysplasia.[4] Fibromuscular dysplasia is the predominant cause in young patients, usually females under 40 years of age.[5] PathophysiologyThe pathophysiology of renal artery stenosis, leads to changes in the structure of the kidney that are most noticeable in the tubular tissue.[6] If the stenosis is longstanding and severe, the glomerular filtration rate in the affected kidneys never recovers and (prerenal) kidney failure is the result.{{medical citation needed|date=August 2015}} Changes include:[6]
DiagnosisThe diagnosis of renal artery stenosis can use many techniques to determine if the condition is present, a clinical prediction rule is available to guide diagnosis.[7] Among the diagnostic techniques are:
TreatmentAtherosclerotic renal artery stenosisIt is initially treated with medications, including diuretics, and medications for blood pressure control.[6] When high-grade renal artery stenosis is documented and blood pressure cannot be controlled with medication, or if renal function deteriorates, surgery may be resorted to. The most commonly used procedure is a minimally-invasive angioplasty with or without stenting. It is unclear if this approach yields better results than the use of medications alone.[14] It is a relatively safe procedure.[14] If all else fails and the kidney is thought to be worsening hypertension and revascularization with angioplasty or surgery does not work, then surgical removal of the affected kidney (nephrectomy) may significantly improve high blood pressure.[15] Fibromuscular dysplasiaAngioplasty with or without stenting is the best option for the treatment of renal artery stenosis due to fibromuscular dysplasia.[16] See also
References1. ^1 2 {{Cite web|url=http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/renal-artery-stenosis-ras/Pages/facts.aspx |title=Renal Artery Stenosis |website=National Institute of Diabetes and Digestive and Kidney Diseases |accessdate=2015-08-17}} 2. ^{{Cite web|title = Renovascular hypertension: MedlinePlus Medical Encyclopedia|url = https://www.nlm.nih.gov/medlineplus/ency/article/000204.htm|website = www.nlm.nih.gov|accessdate = 2015-08-17}} 3. ^{{Cite journal|title = Flash pulmonary oedema and bilateral renal artery stenosis: the Pickering Syndrome|url = http://eurheartj.oxfordjournals.org/content/early/2011/03/14/eurheartj.ehr056|journal = European Heart Journal|date = 2011-03-15|issn = 0195-668X|pmid = 21406441|pages = 2231–5|doi = 10.1093/eurheartj/ehr056|first = Franz H.|last = Messerli|first2 = Sripal|last2 = Bangalore|first3 = Harikrishna|last3 = Makani|first4 = Stefano F.|last4 = Rimoldi|first5 = Yves|last5 = Allemann|first6 = Christopher J.|last6 = White|first7 = Stephen|last7 = Textor|first8 = Peter|last8 = Sleight|volume=32|issue = 18}} 4. ^{{cite web|title=RenalArtery Stenosis|url=https://www.niddk.nih.gov/health-information/health-topics/kidney-disease/renal-artery-stenosis-ras/Documents/RenalArteryStenosis_508.pdf|website=NIH|publisher=National Institute of Health|accessdate=1 August 2016}} 5. ^{{Cite journal|title = Fibromuscular Dysplasia: Practice Essentials, Background, Pathophysiology|url = http://emedicine.medscape.com/article/1161248-overview#a6|date = 2018-09-19}} 6. ^1 2 {{Cite journal|title = Renal Artery Stenosis: Background, Pathophysiology, Etiology|url = http://emedicine.medscape.com/article/245023-overview#a5|date = 2018-12-14}} 7. ^{{Cite book|title = Clinical Prediction Models: A Practical Approach to Development, Validation, and Updating|url = https://books.google.com/?id=kHGK58cLsMIC&pg=PA12&dq=clinical+prediction+rule+is+used+in+renal+artery+stenosis#v=onepage&q=clinical%2520prediction%2520rule%2520is%2520used%2520in%2520renal%2520artery%2520stenosis&f=false|publisher = Springer Science & Business Media|date = 2008-12-16|isbn = 9780387772448|first = Ewout|last = Steyerberg}} 8. ^1 {{Cite journal|title = Doppler ultrasound and renal artery stenosis: An overview|journal = Journal of Ultrasound|date = 2009-10-12|issn = 1971-3495|pmc = 3567456|pmid = 23397022|pages = 133–143|volume = 12|issue = 4|doi = 10.1016/j.jus.2009.09.006|first = A.|last = Granata|first2 = F.|last2 = Fiorini|first3 = S.|last3 = Andrulli|first4 = F.|last4 = Logias|first5 = M.|last5 = Gallieni|first6 = G.|last6 = Romano|first7 = E.|last7 = Sicurezza|first8 = C.E.|last8 = Fiore}} 9. ^{{Cite journal|title = Renal artery stenosis in patients with resistant hypertension|journal = The American Journal of Cardiology|date = 2013-11-01|issn = 1879-1913|pmid = 24135303|pages = 1417–1420|volume = 112|issue = 9|doi = 10.1016/j.amjcard.2013.06.030|first = Marcin|last = Protasiewicz|first2 = Jacek|last2 = Kądziela|first3 = Karol|last3 = Początek|first4 = Rafał|last4 = Poręba|first5 = Maciej|last5 = Podgórski|first6 = Arkadiusz|last6 = Derkacz|first7 = Aleksander|last7 = Prejbisz|first8 = Andrzej|last8 = Mysiak|first9 = Andrzej|last9 = Januszewicz}}{{Subscription or libraries|sentence|via=ScienceDirect}} 10. ^{{Cite book|title = Clinical Examination: A Systematic Guide to Physical Diagnosis|url = https://books.google.com/?id=cTFkBgAAQBAJ&pg=PA208&lpg=PA208&dq=costal+margin+auscultation+renal+artery+stenosis#v=onepage&q=costal%2520margin%2520auscultation%2520renal%2520artery%2520stenosis&f=false|publisher = Elsevier Health Sciences|date = 2013-09-20|isbn = 9780729541473|first = Nicholas Joseph|last = Talley|first2 = Simon|last2 = O'Connor}} 11. ^1 {{Cite book|title = A Clinical Approach to Medicine|url = https://books.google.com/?id=t0KmTrzxAlEC&pg=PA1243&lpg=PA1243&dq=captopril+challenge+test++renal+artery+stenosis#v=onepage&q=captopril%2520challenge%2520test%2520%2520renal%2520artery%2520stenosis&f=false|publisher = World Scientific|date = 2005-01-01|isbn = 9789812560735|first = Yong Yau|last = Ong}} 12. ^{{cite book |last= Sam |first= Amir H. |author2=James T.H. Teo |title= Rapid Medicine |publisher= Wiley-Blackwell |year= 2010 |isbn= 978-1405183239|title-link= Rapid Medicine }} 13. ^{{Cite journal|title = Assessment of the kidneys: magnetic resonance angiography, perfusion and diffusion|url = http://www.jcmr-online.com/content/13/1/70/abstract|journal = Journal of Cardiovascular Magnetic Resonance|date = 2011-11-15|issn = 1532-429X|pmc = 3228749|pmid = 22085467|pages = 70|volume = 13|issue = 1|doi = 10.1186/1532-429X-13-70|first = Ulrike I.|last = Attenberger|first2 = John N.|last2 = Morelli|first3 = Stefan O.|last3 = Schoenberg|first4 = Henrik J.|last4 = Michaely}} 14. ^1 {{cite journal|last1=Jenks|first1=S|last2=Yeoh|first2=SE|last3=Conway|first3=BR|title=Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis.|journal=The Cochrane Database of Systematic Reviews|date=5 December 2014|volume=12|issue=12|pages=CD002944|pmid=25478936|doi=10.1002/14651858.CD002944.pub2}} 15. ^{{Cite book|title = Pediatric Solid Organ Transplantation|url = https://books.google.com/?id=NmHE1XsZ6ScC&pg=PA155&dq=nephrectomy)++may+reduce+hypertension#v=onepage&q=nephrectomy)%2520%2520may%2520reduce%2520hypertension&f=false|publisher = John Wiley & Sons|date = 2009-04-08|isbn = 9781444312737|first = Richard N.|last = Fine|first2 = Steven A.|last2 = Webber|first3 = William E.|last3 = Harmon|first4 = Deirdre|last4 = Kelly|first5 = Kim M.|last5 = Olthoff}} 16. ^{{Cite journal|title = Treatment of hypertension in patients with renal artery stenosis due to fibromuscular dysplasia of the renal arteries - Chrysant - Cardiovascular Diagnosis and Therapy|issue = 1|pages = 36–43|url = http://www.thecdt.org/article/view/3369/4207|journal = Cardiovascular Diagnosis and Therapy|volume = 4|accessdate = 2015-08-17|date = 2014-02-21|last1 = Chrysant|first1 = Steven G.|last2 = Chrysant|first2 = George S.|pmid = 24649423|pmc = 3943779|doi = 10.3978/j.issn.2223-3652.2014.02.01}} Further reading
External links{{Medical resources| DiseasesDB = 11255 | ICD10 = I70.1 | ICD9 = {{ICD9|440.1}} | ICDO = | OMIM = | MedlinePlus = 001273 | eMedicineSubj = med | eMedicineTopic = 2001 | MeshID = D012078 }}{{Vascular diseases}}{{Nephrology}} 2 : Kidney diseases|Articles containing video clips |
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