Renal Hypertension
Renal hypertension will occur when a person has renal artery stenosis, due to narrowing of the arteries in the kidneys being blocked partially or fully, not allowing blood to flow to the kidney. When this happens, a hormone is released making the blood pressure rise. This is called the activation of the renin-angiotensin- aldosterone mechanism. (Norris and Tuan, 2020). Renal hypertension accounts for up to 2 percent of all hypertension cases. (Norris and Tuan, 2020).
Two causes for renal hypertension are, atherosclerosis and fibromuscular dysplasia. Atherosclerosis is most common in older adults and is caused by plaque, made up of fat, cholesterol, calcium and other substances, inducing hardening and narrowing of the renal arteries. Fibromuscular dysplasia is more common in women and younger people that develop high blood pressure. This causes narrowing of the blood vessel walls. (Cleveland Clinic,2020).
Risk factors of renal hypertension include high blood pressure that is uncontrolled, even with medication. Typically, a patient with renal hypertension will be on three or more medications including a diuretic for their blood pressure and it will not be normalized. Another risk factor would be someone who has high blood pressure at a young age or someone that has stable blood pressure that suddenly rises or becomes uncontrolled. Kidney disease, narrowing of other arteries in the body, or build up of fluid in the lungs may also put someone at risk for renal hypertension. In order to keep risk factors decreased, a heart healthy diet should be followed, you should exercise regularly, keep weight under control, do not smoke, cut back on alcohol, limit caffeine and sodium and reduce or avoid stress.
Renal hypertension, can affect other areas of the body, such as the heart. When your kidneys are not working well, it may cause fluid build up in the lungs and around the heart and will also make the heart pump harder. This can lead to a heart attack or stroke.
Renal hypertension is diagnosed by monitoring blood pressure regularly, with a physical exam and getting a thorough medical history from the patient. A doctor will listen to the patients neck or belly for narrowing of the arteries, by hearing a whooshing sound, called a bruit. ( Cleveland Clinic, 2020). Monitoring kidney function through blood tests and doing a renal duplex ultrasound will show if arteries are blocked. A CTA, MRA or catheter angiogram will show the flow of blood through the kidney arteries. Treatment for renal hypertension would include education of risk factors, medication for blood pressure, being ACE inhibitors or ARBs, with a diuretic for kidney function. If medication alone doesnt control blood pressure, a patient may need a renal angioplasty with stenting. One thing I learned from my article is that men and women age 67 and older and Caucasian are most likely to have renal hypertension.
References
Norris, T. and Tuan, R. (2020). Porths essentials of pathophysiology (5th ed.).Wolters Kluwer.
https://coursepoint.vitalsource.com/
Cleveland Clinic. (14 December, 2020). Renal hypertension: cause & treatment.
https://my.clevelandclinic.org/health/diseases/16459-renal-hypertension
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