What is it?

Hypertensive renal disease, renal hypertension or renovascular hypertension all refer to a high blood pressure caused by narrowing of the arteries. As a result, the kidney senses that it is not getting enough blood, thus producing a hormone that increases blood pressure. Then, the pressure on the kidney’s blood vessels increases as well, causing them to thicken. The kidney’s job is to filtrate the blood and produce urine. When the blood pressure rises, the filtering units can form scars. The changes mentioned result in chronic kidney disease that may lead to further elevation of blood pressure by releasing hormones or by salt and fluid retention. Atherosclerosis is the most common cause of renal artery stenosis. Another cause can be fibromuscular dysplasia (FMD) which is more common in women and in younger people.

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Additional names

This group contains additional names:
- Malignant Hypertensive Chronic Kidney Disease with CKD stage I-IV
- Arteriolar nephrosclerosis
- Malignant htn ckd
- Malignant hypertensive CKD
- Severe chronic kidney failure with hypertension
- Malignant Hypertensive Chronic Kidney Disease with CKD stage V or End Stage Renal Disease

Signs & symptoms

Hypertensive renal disease is hard to diagnose. It has to be suspected when there is :
-High blood pressure that is not controlled on three or more medications at their maximum dosages, including a diuretic.
-High blood pressure at a young age
-A stable high blood pressure that suddenly worsened
-Narrowing of other arteries in the body.
-Acute kidney injury
-Pulmonary edema

Diagnosis

Diagnosis of hypertensive renal disease is based upon findings from medical history and physical examination. The doctor may identify narrowed renal arteries by listening with a stethoscope and hearing a bruit. Imaging tests may be done to view the arteries such as duplex ultrasound, CT angiography, magnetic resonance angiogram (MRA) and a catheter angiogram.

Treatment

When diagnosed with hypertensive renal disease, usually the patient is already on medicines for high blood pressure. Then, the doctors may start to perform changes in the types of medication, the dosage or the way it is taken. Angiotensin-converting enzyme (ACE) inhibitors. and angiotensin receptor blockers (ARBs) are proved to be renal protective. Angioplasty with stenting of the renal arteries may also be an option for severe narrowing, an acute kidney injury or an uncontrollable high blood pressure.

☝️ This is not a substitute for professional medical advice. Please consult with your physician before making any medical decision.

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