Renovascular disease natural history, complications and prognosis: Difference between revisions

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==Prognosis==
==Prognosis==
 
===Favorable Predictors===
'''Successful Outcome For Control Of Hypertension'''
*Rapid acceleration of hypertension over the prior weeks or months
*Presence of “malignant” hypertension
*Hypertension in association with flash pulmonary edema
*Contemporaneous rise in serum creatinine
*Development of azotemia in response to ACE inhibitors administered for control of hypertension.
'''Successful Salvage Or Preservation Of Renal Function'''
*Recent rapid  rise in creatinine, unexplained by other factors
*Azotemia resulting from  ACE inhibitors
*Absence of diabetes or other cause of intrinsic kidney disease
*Presence of global renal ischemia, wherein the entire functioning renal mass is subtended by bilateral critically narrowed renal arteries or a vessel supplying a solitary kidney.
===Unfavorable Predictors===
*Renal atrophy demonstrated by kidney length <7.5 cm on ultrasound
*High renal resistance index detected by duplex ultrasound
*Proteinuria > 1gm/day
*Hyperuricemia
*Creatinine clearance <40 mL/minute


==References==
==References==

Revision as of 18:18, 28 September 2012

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Overview

Natural History

Complications

Prognosis

Favorable Predictors

Successful Outcome For Control Of Hypertension

  • Rapid acceleration of hypertension over the prior weeks or months
  • Presence of “malignant” hypertension
  • Hypertension in association with flash pulmonary edema
  • Contemporaneous rise in serum creatinine
  • Development of azotemia in response to ACE inhibitors administered for control of hypertension.

Successful Salvage Or Preservation Of Renal Function

  • Recent rapid rise in creatinine, unexplained by other factors
  • Azotemia resulting from ACE inhibitors
  • Absence of diabetes or other cause of intrinsic kidney disease
  • Presence of global renal ischemia, wherein the entire functioning renal mass is subtended by bilateral critically narrowed renal arteries or a vessel supplying a solitary kidney.

Unfavorable Predictors

  • Renal atrophy demonstrated by kidney length <7.5 cm on ultrasound
  • High renal resistance index detected by duplex ultrasound
  • Proteinuria > 1gm/day
  • Hyperuricemia
  • Creatinine clearance <40 mL/minute

References


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