Abstract:
This presentation is a review of international literature that elucidates the clinical
manifestation, management of treatment, and mechanisms of renovascular hypertension. Another
object of our work is to report some real clinical cases relating to this study and make a difference
between international and Moldavian practice in the management of patients with renovascular
hypertension. Hypertension in the presence of renal artery stenosis may not necessarily be
renovascular hypertension. The two conditions may simply co-exist. Renovascular hypertension is
usually symptomless, while hypertension that is difficult to control with antihypertensive therapy is
probably the best indication as to whether further diagnostic evaluation is indicated. Some features of
renovascular hypertension include: a worse prognosis than essential hypertension, less amenable to
drug treatment, a greater risk of dose-dependent side effects, a higher risk of progression to
accelerated hypertension and it may result in irreversible ischaemic failure of the affected kidney.
Renal artery stenosis may be present in up to 30% of drug resistant hypertensive patients.
Arteriosclerotic renovascular disease is an increasingly important cause of renal failure. Functional
diagnostic tests for renovascular hypertension such as rapid sequence intravenous urography have
now been superseded by the captopril challenge test and in particular scintigraphy following captopril
provocation. Tests of prediction as to whether correction of a demonstrated renal artery stenosis will
lead to an improvement in the blood pressure include renal vein renin estimations and scintigraphy.
The key diagnostic procedure is renal angiography. The approaches to management primarily include
appropriate antihypertensive therapy, while there is an increasing place for percutaneous transluminal
angioplasty, with or without stenting of an occluding lesion. There is still a small place for corrective
surgery. Renal ischaemia due to atherosclerotic renovascular disease is becoming an increasing
problem in nephrology. Treatment should be directed at preserving or even restoring renal function.
