Figure 34

Frequency and natural history of fibrous renal artery diseases. There are four types of fibrous renal artery disease (fibrous dysplasias): medial fibroplasia, perimedial fibroplasia, intimal fibroplasia, and medial hyperplasia. Although the true incidence of these specific types of fibrous renal artery disease is not clearly defined, medial fibroplasia is the most common, estimated to account for 70% to 85% of fibrous renal artery disease. The majority of patients with medial fibroplasia are almost exclusively women who are diagnosed between the ages of 25 to 50 years. Although medial fibroplasia progresses to higher degrees of stenosis in about one third of cases, complete arterial occlusion or ischemic atrophy of the involved kidney is rare. Intervention on this type of fibrosis dysplasia is for relief of hypertension because the threat of progressive medial fibroplasia to renal function is negligible. Perimedial fibroplasia is the second most common type of fibrous dysplasia, accounting for 10% to 25% of fibrous renal artery lesions. This lesion also occurs predominantly in women, is diagnosed between the ages of 15 and 30, is frequently bilateral and highly stenotic, and may progress to total arterial occlusion. These patients should undergo surgical renal revascularization to relieve hypertension and to avoid loss of renal function. Intimal fibroplasia and medial hyperplasia (usually indistinguishable angio-graphically) are not common, accounting for only 5% to 10% of fibrous renal artery lesions. Intimal fibroplasia occurs primarily in children and adolescents. Medial hyperplasia is found predominantly in adolescents; angio-graphically it appears as a smooth linear stenosis that may extend into the primary renal artery branches. Medial hyperplasia, like intimal fibroplasia, is a progressive lesion and is associated with ipsilateral renal atrophy. Surgical renal revascularization is recommended for patients with either intimal fibroplasia or medial hyperplasia to avoid lifelong antihyper-tensive therapy and to avert renal atrophy.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

Get My Free Ebook


Post a comment