American Urological Association - Renovascular Hypertension: Atherosclerotic Disease
Renovascular Hypertension: Atherosclerotic Disease
- Renovascular hypertension is defined as hypertension resulting from eccentric atheromatous narrowing of renal artery lumen.
- Represents 2-5% of hypertensive cases, but is important because it is curable.
- Two major causes: atherosclerosis and fibromuscular dysplasias.
- Atherosclerosis is the most common cause (60-70%) of renovascular hypertension affecting mainly older individuals.
- More common in male.
- Has higher incidence in elderly and diabetics.
- Atheromatous plaque at origin of renal artery from aorta (involved ~50%).
- May show recent thrombosis.
- Kidney is small (usually <1/2 normal weight).
- Bilateral in ~60% of cases.
- Proliferation of smooth muscle (myointimal) cells in arterial intima (image A).
- Lipid deposition (cholesterol clefts), histiocytic infiltration (foam cells), necrosis and fibrosis result in narrowing of arterial lumen (image B).
- Surgical removal results in cure rate of 60-75% of patients.
- With 75% narrowing, ischemic renal disease may occur.