Renovascular hypertension: anatomic and renal function changes during drug therapy

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Vascular Surgery

Background:

• Renovascular hypertension (RVH) is a significant cause of secondary hypertension.
• Atherosclerotic renal artery disease is a leading cause of RVH.
• Nonoperative management is an option for selected patients with RVH.

Purpose of the Study:

• To evaluate the natural progression of renal function and size in patients with atherosclerotic renal artery disease and RVH managed nonoperatively.
• To determine the rate of renal function deterioration and the need for intervention in this patient cohort.

Main Methods:

• Serial renal function studies (serum creatinine, glomerular filtration rate) were performed.
• Renal length and degree of stenosis were monitored.
• Patients were randomly selected for nonoperative management.

Main Results:

• Significant increases in serum creatinine (25-120%) occurred in 19 patients.
• Glomerular filtration rates dropped by 25-50% in 12 patients.
• Renal length loss (>10%) occurred in 37% of patients, and 12% experienced stenosis progression to occlusion.
• 41% of patients required surgery due to renal function or size deterioration, often despite controlled blood pressure.

Conclusions:

• Progressive renal function deterioration and loss of renal size are common in nonoperatively managed patients with atherosclerotic RVH.
• This progression can occur even when blood pressure is adequately controlled with medication.
• Close monitoring is crucial for patients with atherosclerotic renal artery stenosis and RVH undergoing nonoperative management.