محفوظ في:
| المؤلف الرئيسي: | |
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| التنسيق: | Recurso digital |
| اللغة: | |
| منشور في: |
Zenodo
2025
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| الموضوعات: | |
| الوصول للمادة أونلاين: | https://doi.org/10.5281/zenodo.15828013 |
| الوسوم: |
إضافة وسم
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جدول المحتويات:
- <p>Introduction: Although essential hypertension is the main cause of hypertension, 10% of patients with hypertension have secondary hypertension (Rossi et al., 2020). One of the important causes of secondary hypertension is renal artery stenosis (RAS). Resistant or sudden-onset hypertension (especially in young patients), unresponsiveness to medications, deteriorating renal function, abdominal systolic murmur, acute pulmonary edema and asymmetric kidney sizes may raise suspicion in the diagnosis. In patients with suspected RAS, diagnosis is made with imaging methods and laboratory tests. Renal artery stenosis is associated with hyperreninemic hyperaldosteronism characterized by the presence of hypokalemia and metabolic alkalosis. Renal doppler ultrasonography is preferred as the first step and non-invasive imaging method. Computed tomography angiography or magnetic resonance angiography can be used, but definitive diagnosis is made with renal artery angiography, which is considered the gold standard. Treatment of patients includes the use of renin-angiotensin-aldosterone system antagonists, antiplatelets in case of atherosclerotic disease, statins, diet and lifestyle changes (Colbert, Abra, & Lerma, 2021). Percutaneous angioplasty with or without stents and rarely surgical revascularization can be applied in selected patients.</p> <p>Case 1: A 65-year-old male patient applied to our clinic with complaints of dizziness. The patient developed treatment resistant hypertension and renal function deterioration in the last year. Doppler ultrasonography revealed 80% stenosis in the proximal left renal artery, and angiography revealed 80% stenosis in the proximal and 90% stenosis in the distal.</p> <p>Case 2: A 58-year-old female patient applied to our clinic with complaints of severe headaches. The patient's medical history showed emergency admissions with recurrent pulmonary edema. Doppler ultrasonography revealed a 75% stenosis in the left renal artery, and angiography revealed an 85% stenosis in the left renal artery.</p> <p>The decision to revascularize was made due to the patients' resistant hypertension despite maximum medical treatment, renal function deterioration and recurrent flash pulmonary edema in the second case. The patients underwent balloon angioplasty followed by stenting. Blood pressure decreased and renal function improved in the follow-up after revascularization, and no recurrence of pulmonary edema occurred in the second case in the 1-year follow-up.</p> <p>Conclusion: Renal artery stenosis is an important but often overlooked cause of secondary hypertension. Renal artery stenosis should be considered especially in young patients, those with resistant hypertension or those experiencing rapid renal function loss. Increasing awareness of secondary hypertension in the family medicine clinic is of critical importance in terms of early diagnosis and directing to the correct treatment.</p>