Stenosis Renal arteries

Despite their clear benefits, ACE inhibitors are still underutilized in HF. One reason is undue concern or confusion regarding absolute versus relative contraindications for their use. Absolute contraindications include a history of angioedema, bilateral renal artery stenosis, and pregnancy. Relative contraindications include unilateral renal artery stenosis, renal insufficiency, hypotension, hyperkalemia, and cough. Relative contraindications provide a warning that close monitoring is required, but they do not necessarily preclude their use. 

Patients with renal artery stenosis may have an abdominal systolic-diastolic bruit. 

Acute renal failure is a rare but serious side effect of ACE inhibitors preexisting kidney disease increases the risk. Bilateral renal artery stenosis or unilateral stenosis of a solitary functioning kidney renders patients dependent on the vasoconstrictive effect of angiotensin II on efferent arterioles, making these patients particularly susceptible to acute renal failure. 

ACE inhibitors, ARBs, and direct renin inhibitors are contraindicated in sexually active girls because of potential teratogenic effect and in those who might have bilateral renal artery stenosis or unilateral stenosis in a solitary kidney. 

Isolated renal hypoperfusion Bilateral renal artery stenosis (unilateral renal artery stenosis in solitary kidney) Emboli Cholesterol Thrombotic Medications Cyclosporine Angiotensin-converting enzyme inhibitors Nonsteroidal antiinflammatory drugs Radiocontrast media... 

Undesired effects. The magnitude of the antihypertensive effect of ACE inhibitors depends on the functional state of the RAA system. When the latter has been activated by loss of electrolytes and water (resulting from treatment with diuretic drugs), cardiac failure, or renal arterial stenosis, administration of ACE inhibitors may initially cause an excessive fall in blood pressure. In renal arterial stenosis, the RAA system may be needed for maintaining renal function and ACE inhibitors may precipitate renal failure. Dry cough is a fairly frequent side effect, possibly caused by reduced inactivation of kinins in the bronchial mucosa. Rarely, disturbances of taste sensation, exanthema, neutropenia, proteinuria, and angioneurotic edema may occur. In most cases, ACE inhibitors are well tolerated and effective. Newer analogues include lisinopril, perindo-pril, ramipril, quinapril, fosinopril, benazepril, cilazapril, and trandolapril. 

Renal function impairment Some hypertensive patients with renal disease, particularly those with severe renal artery stenosis, have developed increases in BUN and serum creatinine after reduction of BP. 

Left ventricular dysfunction Post-myocardial infarction Non-diabetic nephropathy Type 1 diabetic nephropathy Type 2 diabetes mellitus Proteinuria Hyperkalaemia Bilateral renal artery stenosis disease... 

ARBs Type 2 diabetic nephropathy Type 2 diabetic microalbuminuria Proteinuria Left ventricular hypertrophy ACE-I cough or intolerance Pregnancy Hyperkalaemia Bilateral renal artery stenosis ... 

Unlabeled Uses Diagnosis of anatomic renal artery stenosis, hypertensive crisis, rheumatoid arthritis... 

Unlabeled Uses Diabetic nephropathy, hypertension due to scleroderma renal crisis, hypertensive crisis, idiopathic edema, renal artery stenosis, rheumatoid arthritis, post Ml for prevention of ventricular failure... 

Contraindications Bilateral renal artery stenosis, hyperaldosteronism... 

Contraindications Bilateral renal artery stenosis, biliary cirrhosis or obstruction, primary hyperaldosteronism, severe hepatic insufficiency... 

Contraindications Bilateral renal artery stenosis, history of angioedema from previous treafmenf wifh ACE inhibitors... 

A reduction of renin-angiotensin-aldosterone activity is therapeutically beneficial in patients with hypertension, heart failure or renal artery stenosis. 

Severe hypotension can occur after initial doses of any ACE inhibitor in patients who are hypovolemic as a result of diuretics, salt restriction, or gastrointestinal fluid loss. Other adverse effects common to all ACE inhibitors include acute renal failure (particularly in patients with bilateral renal artery stenosis or stenosis of the renal artery of a solitary kidney), hyperkalemia, dry cough sometimes accompanied by wheezing, and angioedema. Hyperkalemia is more likely to occur in patients with renal insufficiency or diabetes. Bradykinin and substance P seem to be responsible for the cough and angioedema seen with ACE inhibition. 

A 64-year-old man with type II diabetes, hypertension, and bilateral renal artery stenosis presented with confusion and dysarthria related to profound hypoglycemia (2.2 mmol/1). He was taking naproxen 500 mg bd, ramipril 2.5 mg/day, glibenclamide 2.5 mg bd, metformin 850 mg bd, a thiazide diuretic, terazosin, ranitidine, paracetamol, and codeine. His plasma creatinine concentration, previously 185 pmol/1, was 362 pmol/1 and it fell to 210 imol/l after the withdrawal of ramipril and naproxen. 

I use Nipride, which I have never had fail to control the BP in patients with Cushing s, primary aldosteronism, renal artery stenosis, pheochromocytoma, and scleroderma with malignant hypertension. 

Labs lytes, blood urea nitrogen (BUN)/creatinine, urine albumin, plasma aldosterone/plasma renin ratio to screen for excess aldosterone or mineralocorticoid production, or renin for renal artery stenosis (RAS) or renin-secreting tumor. 

If you would do an angioplasty or an operation, do classical renal arteriogram—not MRAor nuclear scan the only way to exclude renal artery stenosis as a cause of HTN is by selective transfemoral angiography to get details of main and branch renal arteries. 

X-rays, angiography and scans confirmed that Billie s problem was renal artery stenosis, a condition most commonly seen in females of20-50 years of age. Removal of the obstruction to renal blood flow is required to reduce BP permanently, but in the short term drug treatment will be needed to lower BP to an acceptable range. 

QIO Renal artery stenosis causes the kidney to become ischaemic. How does this result in high BP ... 

Only 5-10% of hypertension has a known cause in these cases, it is secondary to a condition such as a tumour of the adrenal medulla, pre-eclampsia during pregnancy, renal disease or renal artery stenosis. Removal of the primary cause, such as stenosis of the renal artery, resolves the hypertension. 

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