Management Of Renal Hypertension

During the last few years, renal hypertension has become a subject of increasing importance. The development of improved radiological techniques, notably intravenous and intra-arterial digital subtraction angiography, has made the diagnosis of renal artery stenosis more reliable, while advances in vascular surgery and the introduction of percutaneous trans luminal angioplasty have caused major changes in clinical practice. The increasing use of such potent antihypertensive agents as the angiotensin I converting enzyme inhibitors has empha sized the problem of renal artery stenosis in older patients with wide spread vascular disease as well as improving the prognosis of patients with accelerated hypertension. This book examines the surgical and medical aspects of renal hyper tension in the light of these recent advances. Each chapter has been written by a recognized expert in the field and provides information of relevance and practical importance to the average clinician. The developments of the last decade have emphasized that renal hyper tension is no longer a matter only for the nephrologist but a subject on which all clinicians should be well informed.

The treatment of hypertension has become the most important intervention in the management of all forms of chronic kidney disease. Chronic Kidney Disease and Hypertension is a current, concise, and practical guide to the identification, treatment and management of hypertension in patients with chronic kidney disease. In depth chapters discuss many relevant clinical questions and the future of treatment through medications and or novel new devices. Written by expert authors, Chronic Kidney Disease and Hypertension provides an up-to-date perspective on management and treatment and how it may re-shape practice approaches tomorrow.

Hypertension is fast becoming a pandemic of enormous proportions, and its sequelae of cardiovascular and cerebrovascular adverse events is making it a leading cause of morbidity and mortality worldwide. The interrelationship of hypertension and kidney changes though established for quite some time, the exact mechanisms and causality are still being discovered. The role of kidney as evidenced by subtle changes in the initiation of ‘primary hypertension’ is increasingly being scrutinized. The effects of established renal causes that induce hypertension such as renal artery stenosis are well established. Pediatric population is also no longer immune to this potentially debilitating condition. This book will help the readers to: Understand the intricacies of the genesis of hypertension and its effects on the kidney Explore the various established guidelines and newer promising aspects in diagnosis and management of hypertension and the kidney changes Know the newer emerging concepts in the treatment of hypertension in the pediatric population Enlighten them about the benefits of timely management of the condition to prevent its progression to end-stage kidney disease, which requires expensive and invasive interventions not suitable to majority of population in a developing country like ours. This book aims to guide the practitioner to diagnose and manage hypertension in the setting of suspected, diagnosed, or established kidney disease with special reference to practical experience in India.

Blood pressure control is central to all bodily functions. There are many points in the multifaceted cybernetic system wherein hypertension may be produced. Hypertension is a 'young' disorder whose existence has been known for less than a century. It is not only extremely prevalent among every popula tion, but also deleterious to the health of mankind. The more we understand about hypertension's harmful effects, the more urgent is the need for its effective control. The kidney is the central organ that controls vascular tone and body fluid volume; these two factors are dominant in determining arterial blood pres sure. Hence, it is not surprising to find in hypertensive disorders that there are abnormalities in the kidneys, functional or anatomical, subtle or overt, that cause or are the consequence of hypertension. The first suggestion that the kidney could cause hypertension was made in 1836, before arterial pressure could even be measured, by Richard Bright. He observed that cardiac hypertrophy was often present in patients who died of renal disease. It was, however, Goldblatt and his colleagues in 1934 who opened the modern era of experimental and clinical research in renal hypertension. Since then, although far from complete, enthusiastic and intensive research efforts have greatly improved our understanding of the nature of renal hypertension.

This monograph provides a timely update on the pathophysiology, diagnosis, and therapy of renovascular and renal parenchymatous hypertension. The underlying causes of the most common forms of hypertension are discussed in separate chapters. Special emphasis is laid on newer pathophysiological aspects of the disease, in particular the vascular wall renin-angiotensin system. Furthermore, there is in depth discussion of all the new techniques that are currently available for use in the diagnosis of renal hypertension, e.g., ultrasound and Doppler techniques, magnetic resonance imaging, and nuclear renography. These techniques are discussed by internationally renowned experts in the field. The book also covers topics such as the value of medical therapy, surgical techniques, and percutaneous transluminal angioplasty, with special reference to the treatment of renal hypertension.

Diagnostic and therapeutic methods and controversies in the management of renovascular hypertension have undergone major ch- ges during the past few years. This book is based on the proceedings of a successful postgraduate Boerhaave Course held in 1982 at the Faculty of Medicine of the University of Leiden, The Netherlands. Current concepts concerning the diagnosis and treatment of reno vascular hypertension were presented during this course to an audience composed of physicians, nephrologists, cardiologists, surgeons, uro logists, and radiologists. Thus, this book aims at offering an overview of tho,se aspects of renovascular hypertension which are relevant to clinical pr- tice. An effort is made to review the currently available moda lities of diagnostic procedures, both on the basis of modern in sights in the pathology and pathophysiology of renovascular hyper tension, as well as timely r'esul ts of clinical research. In ad dition, several chapters deal with combinations of these di- nostic procedures in a fashion that can be of practical help in clin;cal decision making. The medical, surgical and angioplastic modalities of treatment are reviewed. Basic considerations concerning medical treatment and technical aspects of surgical as well as per cutaneous angioplasty are presented in detail, both separately and in combination. Special attention is given to the problem of renal artery stenosjs in k~dney transplants. This book offers up to date information on clinical aspects of renovascular hypertension, useful to a wide range of clinicians in a variety of disciplines.