What is Renal Hypertension?

Renal hypertension, also called renovascular hypertension, is high blood pressure resulting from narrowing of your arteries that carry blood to your kidneys. It can sometimes be referred to as renal artery stenosis. Since your kidneys have inadequate blood supply, they will respond by producing a hormone that elevates the pressures in your blood vessels.

It is a form of treatable hypertension if diagnosed appropriately.

Over 67 years of age - men and women are more likely to have renal hypertension, but it can develop at any age.

What are the symptoms or signs of renal hypertension?

Even though renal hypertension can't be easily diagnosed, often with no symptoms, watch for the following signs:

Uncontrolled high blood pressure that is on three or more antihypertensive medications at maximal doses, including one or more diuretics.
High blood pressure in which the blood pressure development appears early, typically in young people.
Stable hypertension that suddenly worsens and/or becomes difficult to control.
Acute and often non worsening renal failure that cannot be explained, or that progresses quickly.
Coronary, carotid, or other forms of atherosclerotic artery disease that can lead to conditions as clinically evident as angina, stroke, or branch retinal artery occlusions.
Rapid onset of accumulation inside the lungs of fluid; known as pulmonary edema.

What is the cause of renal hypertension?

Renal hypertension is caused by a part or total bock of the arteries that supply blood to your kidneys. These renal (kidney) arteries carry blood rich in oxygen and nutrients from your heart to your kidneys. If your kidneys don't get enough blood or oxygen, it might be because these renal arteries are narrowed, a condition called renal artery stenosis.

Atherosclerosis, or the hardening of arteries, is the most prevalent cause of renal artery stenosis. A combination of fat, cholesterol, calcium, and other substances builds inside your arteries and becomes hardened into narrow strata: plaque. It could obstruct the blood in a whole or partially within an artery found in the heart, brain, pelvis, legs, arms, or kidneys.

Another cause of renal artery stenosis is fibro muscular dysplasia (FMD). Although the cause of FMD is unknown, it is unique because it doesn't result from the build-up of plaque in your blood vessel walls, but rather by the narrowing of these walls themselves. FMD tends to occur more commonly in women and should be considered in the case of younger patients who develop high blood pressure.

Other causes include:

Arteritides.
Radiation fibrosis.
Arteries blocked by grafts.

How is renal hypertension diagnosed?

It is important to go regularly to a healthcare provider to have your blood pressure numbers monitored and kept in a healthy range. Your healthcare provider can suggest blood tests.

A patient can give clues suggesting the presence of vascular disease based on his or her history and a full physical examination conducted by his or her healthcare provider. If you have a history of other vascular diseases, such as heart attacks or strokes, you are at a higher risk of having renal artery stenosis. One exam, using a stethoscope to listen over the neck or belly, may even identify narrowed arteries. When blood flows through a narrowed artery it sometimes makes a whooshing sound, called a bruit.

A healthcare provider may use one of the imaging tests listed below to search for narrowed kidney arteries. Finding a narrowed kidney artery is not sufficient to diagnose your high blood pressure as caused by renal hypertension. Many people have some degree of narrowing of the kidney arteries without having high blood pressure or with high blood pressure that isn't caused by the narrowing (essential hypertension). The healthcare provider will likely need to use other clinical clues to determine if the two are associated.

Imaging tests that may be performed to diagnose whether the kidneys' arteries have narrowed include:

Duplex ultrasound: It is possible for ultrasound tests to detect renal artery blockage and high-speed blood flow. This is non-invasive, but it does not detect all cases, does not determine artery narrowing, and may be less accurate if one is not skilled.
Computerized tomographic angiography or CTA: In this test, x-rays and computer help generate images of the arteries; a contrast medium is injected via veins in the arm. This diagnostic test is quick and painless; it doesn't provoke claustrophobia either. However, there may be an issue with radiation exposure in kidney function patients.
Magnetic Resonance Angiogram or MRA: This procedure makes use of a contrast dye to view flow of blood and organs, without any need to take x-rays. Patients are not sedated, though some minor muscle relaxation is offered if needed. There is no utilization of ionizing radiation, although the patient will still experience some claustrophobia from having to squeeze into that narrow tube.
Catheter angiogram: This is an invasive radiologic procedure in which a catheter is placed within large arteries guided to the renal artery, thus making the renal artery more clearly seen. It is considered to be much more accurate than other tests, which can also be dilated with a balloon or stented. It's usually reserved for patients with positive results from other tests.

What procedures can help manage renal hypertension?

The intra-arterial injection of an angioplasty material along with stenting makes the path easier for free flow of blood into the kidney from the artery. Those who should undergo this treatment are:

Significant narrowing of the renal artery.
Not manageable blood pressure on medication.
Poor function of the kidney with a deteriorating progress.

An angioplasty is when a doctor places an angio catheter inside an artery, which contains an inflatable balloon used to dilate the vessel. The balloon is inflated and then deflated several times to flatten plaque. The catheter and balloon are withdrawn. Stenting usually goes hand in hand with angioplasty. This is the placing of a small mesh tube inside the narrowed renal artery to support it.

What medications may be used to help treat renal hypertension?

Healthcare professionals suspect renal hypertension, probably on medication to regulate blood pressure. There are many different kinds and the use for a client is determined by the provider. Remember:

Typically, more than one kind of medicine will be ordered.
The amount and/or the kind of medicine may need to be adjusted periodically.
Take all medicines exactly as your healthcare professional has prescribed.
In renal hypertension, specific categories of medications, ACE inhibitors, and angiotensin receptor blockers (ARBs), may be better at lowering your blood pressure than others.

These medicines are used so rarely together that their combined impact on the kidneys is not fully understood but may be a problem in renal artery stenosis. A blood test is important at any point when you are being prescribed these drugs or if you need to be started on, or changed to, one of these medications. A diuretic may be necessary to help the kidneys get rid of excess fluid.

Is renal hypertension curable?

A purely theoretical comment: in theory, if the renal artery stenosis is reversed then so should the hypertension improve.

Are there complications?

You might experience renal hypertension complications which are brought about by this high blood pressure, such as:

Renal failure
Myocardial infarction.
Stroke.
Pulmonary edema.
Retinopathy.
Left ventricular hypertrophy.
Congestive heart failure.
Aneurysm.
Vascular dementia.

What can I do to monitor my high blood pressure?

Control any type of hypertension through having a healthy lifestyle. Modify daily habits as follows:
Eating a heart-healthy diet: Choose fruits, vegetables, grains, and low-fat dairy foods.
Eating regularly, at least 30 minutes a day of moderate activity, such as walking (check with your healthcare provider before starting an exercise program).
Controlling your weight: Discuss with your doctor, if needed, a plan to lose weight.
Smoking cessation, if applicable
Reduce intake of liquids with alcohol
Decrease your caffeine use.
Lower sodium (salt) intake: Pay attention to nutrition labels on packaged food to determine what one serving is.
Reduce your stress level whenever possible: Many people benefit from regular meditation or yoga.

Is renal hypertension fatal?

Unless your renal hypertension is treated, you will likely end up with an end-stage renal failure, which means that your kidney will just shut down completely. Someone suffering from end-stage renal failure can live for approximately two years.

How do I take care of myself?

Take your medicines and do your best in keeping the blood pressure of your body at its lowest. Keep your body healthy by eating properly, exercising regularly, and quitting smoking. Also, consult for follow up on your appointments with your healthcare provider.

What questions should I ask my healthcare provider about renal hypertension?

How high is my blood pressure?
What medications should I be on?
Should I have surgery?

Why choose Tender Palm Super-Speciality Hospital for Hypertensive Kidney Diseases treatment in Lucknow, India?

Tender Palm Super-Speciality Hospital has the most trusted team of Nephrologists with advanced diagnostic equipment care for Hypertensive Kidney Diseases treatment in Lucknow, India. Our Nephrology department follows international safety standards and has years of experience in successfully managing disease and conditions like Hypertensive Kidney Diseases.