Renal hypertensia

Description:

Nephrogenic hypertensia is the increase in arterial pressure arising owing to pathology of kidneys. Differs in extremely high figures of diastolic pressure, resistance to hypotensive drugs and a current zlokachestvennost.
Nephrogenic hypertensia is divided into 2 types:
1. Renovascular.
2. Parenchymatous.
Renovascular - inborn or acquired one - or bilateral defeat of a.renalis.
Parenchymatous - is caused by parenchymatous diseases and damages of kidneys (pyelonephritis, tumors, a glomerulonephritis, MKB, TVS, cysts, a hydronephrosis, a polycystosis, etc.)

Symptoms of Renal hypertensia:

At 33% the age is younger than 50 years, atherosclerotic defeats are more often than the man at the age of more than 40 years, a fibromuskulyarny stenosis at women of young age.
Total absence of complaints, accidentally revealed increase in the ABP is characteristic.
At NP - increase in the ABP costing + a headache + a back pain.
NGG is characterized by sudden emergence and a malignant current (18-30%). Sharp increase in diastolic pressure (higher than 110-120 mm Hg) is characteristic, seldom is followed by crises.

Reasons of Renal hypertensia:

Reasons:
1. An artery stenosis most often due to adjournment of atherosclerotic plaques in an artery gleam;
2. The Fibromuskulyarny dysplasia of a muscular wall of an artery (deficit of elastic fabric leads to a compensatory hypertrophy and proliferation of fibrous fabric, owing to what - to multiple circular fibrosis)
3. Nephroptosis. Until recently as to it paid to NGG reason not enough attention. However recently it is established that an excessive tension and twisting поч. an artery at NP leads to a stenosis it, to the fibromuskulyarny stenosis (orthostatic AG) disappearing in гориз. situation. The hypertension remaining in гориз. situation confirms an organic arteriostenosis.

Treatment of Renal hypertensia:

1. Angioplasty.
Removal of a plaque. Chrezaortalny removal of a plaque, artery resection, patch of autoveny.
2. At a nephroptosis operation of a nephropexy on Pytel - to Lopatkin in combination with artery plastics.
3. At FMS - резекц. arteries, autoplasty (бедр. and hypogastric), обх. an anastomosis with an aorta, an alloplasty. Spleno-renalny anastomosis.
4. At an arrangement in a kidney. Cutting off of a kidney from vessels without crossing of an ureter, the disconnected kidney operation, its change in an ileal pole.
5. Nephrectomy.
Indications:
- a kidney heart attack without hope for recovery.
- multiple defeats,
- stenosis combination to pyelonephritis or atrophy,
- lack of effect of earlier performed operation,
- hopelessness of plastics,
- weight of a state on the accompanying pathology,
- kidney hypoplasia.
Contraindications: bilateral stenosis of renal arteries, existence of an arteriolosclerosis of an opposite kidney.