The most common chronic medical condition in the world is high blood pressure.1,2 It is estimated that approximately 33% of Americans have hypertension and the prevalence is expected to increase by another 7.2% by 2030.2 Hypertension is associated with substantial cardiovascular morbidity and mortality.3 Secondary hypertension has an identifiable and potentially reversible etiology. It is estimated that 10% to 15% of adults and up to 85% of children have secondary hypertension. Secondary hypertension should be suspected in any patient younger than 30 years without a family history of hypertension or obesity, patients with rapid onset or accelerated high blood pressure and patients with refractory hypertension. (see Table 1)4
This chapter will focus on renovascular diseases which include a variety of conditions that affect the renal arterial circulation. Although disorders of the renal vein(s) could correctly be considered renovascular diseases, herein we focus on arterial disorders as primary renal vein disease is far less common. The preponderance of renovascular diseases comprise stenoses of the renal artery resulting from heterogeneous conditions including atherosclerosis, fibrous dysplasia, vasculitis, neurofibromatosis, congenital bands, intrinsic occlusion from endovascular devices, and extrinsic compression from neoplasia and radiation (Table 2). Renal artery stenosis has been shown to cause severe hypertension and renal parenchymal loss and revascularization can lead to improvements in both blood pressure control and renal function. Aneurysms of the main or branch renal arteries are also renovascular diseases.
Hypertension, renal artery stenosis, renovascular disease, atherosclerosis, fibrous dysplasia, renal artery aneurysm.
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