肾血管病的处理-2010.ppt

Management of Renovascular Hypertension 阜外心血管病医院心内科 蒋雄京 Interrelation among Renal Artery Stenosis, Hypertension, and Chronic Renal Failure Angiographic Appearance of the Three Common Forms of Renal Artery Stenosis Prevalence 1. 1~3% in hypertensive population 2. 20~30% in patients with secondary hypertension Incidence of Renal Artery Stenosis at Cardiac Catheterization  Incidence of Renal Artery Stenosis at Cardiac Catheterizationin Chinese population Progressive Atherosclerosis, Renal Artery Stenosis, and Ischemic Nephropathy the clinical manifestations of ARVD Clinical features suggestive of renovascular hypertensionJNC-VI Onset of hypertension aged30 y; Abdominal bruit; Accelerated or resistant hypertension; Flash pulmonary edema with normal left ventricular function; Renal failure of uncertain cause; Coexisting, diffuse atherosclerotic vascular disease Acute renal failure precipitate by antihypertensive therapy, particularly ACEI or AII receptor blockers; In the presence of these clinical clues the prevalence of RVH is 40%. Screening for Renovascular Hypertension 1 .Radionuclide renal fractional flow /GFR 2. Plasma renin activity 3. Captopril renoscitigraphy 4. Color dopplor ultrasonography 5. MR Angiography / CT Angiography Multi-slices CTA is most useful for RAS screening Clinical Criteria for Revascularization Hypertension: accelerated hypertension; refractory hypertension; malignant hypertension; hypertension with a unilateral small kidney; or hypertension with intolerance to medication. Renal salvage: sudden unexplained worsening of renal function; impairment of renal function secondary to antihypertensive treatment, particularly with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker; or renal dysfunction not attributable to another cause. Cardiac disturbance syndromes: recurrent flash pulmonary edema out of proportion to any impairment of left ventricular function,or unstable angina in the setting of