Renal artery stenosis (RAS) is a potentially curable cause of hypertension and azotemia. Besides intra-arterial renal angiography there are several non-invasive techniques utilized to diagnose patients with suspicion of renal artery stenosis. Removing the stenosis by revascularization to restore unobstructed blood flow to the kidney is known to improve and even cure hypertension/azotemia, but is associated with a significant complication rate.To visualize renal arteries with x-ray techniques a contrast medium must be used. In a randomized, prospective study the complications of two types of contrast media (CO2 and ioxaglate) were compared. CO2 was not associated with acute nephropathy, but induced nausea and had lower attenuation differences compared to Ioxaglate…
Contents
INTRODUCTION
2. Historical background
3. Normal kidney function
4. Renal blood flow
4.1 Autoregulation
5. Pathophysiology of renal artery stenosis
5.1 Etiology of renal artery stenosis
6. Prevalence
7. Natural history
8. Hemodynamic effects of arterial stenosis
8.1 Poiseuille´s formula
8.2 Goldblatt models
Two-kidney-one-clip model
One-kidney-one-clip or two-kidney-two-clip model
8.3 Intra-arterial trans-stenotic pressure gradient measurement (PGM)
9. Symptoms of RAS
9.1 Renovascular hypertension
9.2 Renovascular azotemia (ischemic nephropathy)
9.3 Flash pulmonary edema and unstable angina
9.4 Examples of RAS
10. How to treat symptoms secondary to RAS?
11. Predictors for clinical success after revascularisation
12. Economy
13. Diagnostic tests for renal artery stenosis
13.1 Morphological evaluation of RAS
13.2 Digital subtraction angiography (DSA)
13.3 Magnetic resonance angiography (MRA)
13.4 Computed tomography angiography (CTA)
14. Hemodynamic and functional tests for evaluation of RAS
14.1 Duplex US (percutaneous)
14.2 Captopril renography
14.3 Pressure gradient measurement (PGM)
14.4 Intravascular US
14.5 MRA perfusion studies
14.6 CTA split renal function evaluation
15. Complications of PTRA and PTRS
GENERAL AIM
Specific aims
MATERIAL AND METHODS
Patients
Equipment
Technical procedures
DSA
PGM
Duplex US
Captopril Renography
CTA
MRA
RESULTS
Study
GENERAL DISCUSSION
Nephropathy and contrast media
PGM as standard of reference
Imaging for detection of RAS
Treatment of RAS
CONCLUSION
ACKNOWLEDGEMENTS
SUMMARY IN SWEDISH
REFERENCES
Author: Eklof, Hampus
Source: Uppsala University Library
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