肾血管病的处理ppt课件

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1、ManagementofRenovascularHypertension阜外心血管病医院心内科蒋雄京InterrelationamongRenalArteryStenosis,Hypertension,andChronicRenalFailureDefinitionofRenalArteryStenosisRenalarterystenosis(RAS)isdefinedasnarrowingofthelumenoftherenalartery.*angiographicdiameterstenosis>50%*

2、translesionalpressuregradientof>20mmHgpeaksystolicor10mmHgmeanThemostcommoncausesofRASareatherosclerosis(>80%),aortoarteritis(<15%),andfibromusculardysplasia(<5%)inChinaAngiographicAppearanceoftheThreeCommonFormsofRenalArteryStenosisPrevalence1.1~3%inhyperten

3、sivepopulation2.20~30%inpatientswithsecondaryhypertensionIncidenceofRenalArteryStenosisatCardiacCatheterizationAuthorsYearCountryPatientsAgeCAD(%)HT(%)RAS(%)Crowley1998USA141526189726.3Conlon2000Ireland398752100586.3Weber2002Austria17763626711Yamashita2002Jap

4、an2896676487Rihal2002USA29765NA10019.2Buller2004Canada83767683214.3Addad2005Tunisia30058100359CAD=Coronaryarterydisease;HTN=Hypertension;RAS=significantrenalarterystenosis;NA=nonavailable.IncidenceofRenalArteryStenosisatCardiacCatheterizationinChinesepopulati

5、onStudyAuthorsZhangetalPts,n1200RAS>50%9.7Bilateral,%1.7IndicationSuspectedCHDWangetal23014.8NRCHDShenetal28015.35.0SuspectedCHDLiuetal14118.4NRSuspectedCHDMean185111.8NRProgressiveAtherosclerosis,RenalArteryStenosis,andIschemicNephropathytheclinicalmanifestat

6、ionsofARVDClinicalfeaturessuggestiveofrenovascularhypertensionJNC-VIOnsetofhypertensionaged<30y;Abdominalbruit;Acceleratedorresistanthypertension;Flashpulmonaryedemawithnormalleftventricularfunction;Renalfailureofuncertaincause;Coexisting,diffuseatherosclerot

7、icvasculardiseaseAcuterenalfailureprecipitatebyantihypertensivetherapy,particularlyACEIorAIIreceptorblockers;InthepresenceoftheseclinicalcluestheprevalenceofRVHis<40%.ScreeningforRenovascularHypertension1.Radionucliderenalfractionalflow/GFR2.Plasmareninactivit

8、y3.Captoprilrenoscitigraphy4.Colordopplorultrasonography5.MRAngiography/CTAngiographyMulti-slicesCTAismostusefulforRASscreeningSeverityofrenalvasculardiseasepredictsmortalityinpati