Renal artery function. Narrowing of the vessels of the kidneys symptoms. Indirect signs of renal artery stenosis

Renal artery stenosis (RAS) is a serious disease, accompanied by narrowing of the lumen of the vessel that feeds the kidney. Pathology is the responsibility of not only nephrologists, but also cardiologists, since the main manifestation is usually severe hypertension, which is difficult to correct.

Patients with renal artery stenosis are predominantly older people (after 50 years), but stenosis can also be diagnosed in young people. Among the elderly with atherosclerosis of the vessels, there are twice as many men as women, and with congenital vascular pathology, females predominate, in whom the disease manifests itself after 30-40 years.

Every tenth person suffering from high blood pressure has stenosis of the main renal vessels as the main cause of this condition. Today, more than 20 various changes leading to narrowing of the renal arteries (RA), an increase in pressure and secondary sclerotic processes in the parenchyma of the organ.

The prevalence of pathology requires the use of not only modern and accurate diagnostic methods, but also timely and effective treatment. It is recognized that the best results can be achieved with surgical treatment of stenosis, while conservative therapy plays a supporting role.

Causes of VA stenosis

Most common causes narrowing of the renal artery - atherosclerosis and fibromuscular dysplasia of the artery wall. Atherosclerosis accounts for up to 70% of cases, fibromuscular dysplasia accounts for about a third of cases.

Atherosclerosis renal arteries with narrowing of their lumen is usually found in older men, often with existing coronary disease heart disease, diabetes, obesity. Lipid plaques are more often located in the initial segments of the renal vessels, near the aorta, which can also be affected by atherosclerosis, the middle section of the vessels and the branching zone in the parenchyma of the organ are much less often affected.

Fibromuscular dysplasia is a congenital pathology in which the wall of the artery thickens, which leads to a decrease in its lumen. This lesion is usually localized in the middle part of the VA, is 5 times more common in women and may be bilateral.

atherosclerosis (right) and fibromuscular dysplasia (left) are the main causes of VA stenosis

About 5% of spas are caused by other causes, including inflammatory processes vascular walls, aneurysmal expansions, thrombosis and embolism of the arteries of the kidneys, compression by a tumor located outside, Takayasu's disease, prolapse of the kidney. In children, there is an intrauterine developmental disorder of the vascular system with VA stenosis, which manifests itself as hypertension already in childhood.

Both unilateral and bilateral stenosis of the renal arteries is possible. The defeat of both vessels is observed in congenital dysplasia, atherosclerosis, diabetes and proceeds more malignantly, because two kidneys are in a state of ischemia at once.

When blood flow through the renal vessels is disturbed, the system that regulates the level of blood pressure. The hormone renin and angiotensin-converting enzyme contribute to the formation of a substance that causes spasm of small arterioles and an increase in peripheral vascular resistance. The result is hypertension. At the same time, the adrenal glands produce excess aldosterone, under the influence of which fluid and sodium are retained, which also contributes to an increase in pressure.

If even one of the arteries, right or left, is affected, the mechanisms of hypertension described above are triggered. Over time, a healthy kidney "rebuilds" to a new level of pressure, which continues to maintain even if the diseased kidney is completely removed or the blood flow is restored in it by angioplasty.

In addition to activation of the pressure maintenance system, the disease is accompanied by ischemic changes in the kidney itself. Against the backdrop of lack arterial blood tubular dystrophy occurs, connective tissue grows in the stroma and glomeruli of the organ, which inevitably leads to atrophy and nephrosclerosis over time. The kidney condenses, decreases and is unable to perform the functions assigned to it.

Manifestations of SPA

For a long time, SPA can exist asymptomatically or in the form of benign hypertension. Bright Clinical signs diseases appear when the vasoconstriction reaches 70%. Among the symptoms, the most common are secondary renal arterial hypertension and signs of disruption of the parenchyma (decreased urine filtration, intoxication with metabolic products).

Persistent increase in pressure, usually without hypertensive crises, in young patients prompts the doctor to think about possible fibromuscular dysplasia, and if the patient has crossed the 50-year mark, atherosclerotic lesions of the renal vessels are most likely.

Renal hypertension is characterized by an increase in not only systolic, but also diastolic pressure, which can reach 140 mm Hg. Art. and more. This condition is extremely difficult to treat with standard antihypertensive drugs and creates a high risk of cardiovascular accidents, including stroke and myocardial infarction.

Among the complaints of patients with renal hypertension are noted:

Severe headaches, tinnitus, flashing "flies" before the eyes; memory loss and mental performance; Weakness; dizziness; Insomnia or daytime sleepiness; Irritability, emotional instability.

A constant high load on the heart creates conditions for its hypertrophy, patients complain of chest pain, palpitations, a feeling of interruption in the work of the organ, shortness of breath appears, in severe cases, pulmonary edema develops, requiring emergency care.

In addition to hypertension, heaviness and pain in the lumbar region, blood in the urine, and weakness are possible. In case of excess release of aldosterone by the adrenal glands, the patient drinks a lot, emits a large amount of unconcentrated urine not only during the day, but also at night, convulsions are possible.

At initial stage kidney disease is preserved, but hypertension is already appearing, which, however, can be treated with drugs. Subcompensation is characterized by a gradual decrease in kidney function, and in the stage of decompensation there are clearly signs kidney failure. Hypertension in the terminal stage becomes malignant, the pressure reaches its maximum numbers and is not “knocked down” by drugs.

SPA is dangerous not only for its manifestations, but also for complications in the form of cerebral hemorrhages, myocardial infarction, pulmonary edema on the background of hypertension. In most patients, the retina is affected, its detachment and blindness are possible.

Chronic renal failure, as the final stage of the pathology, is accompanied by intoxication with metabolic products, weakness, nausea, headache, a small amount of urine that the kidneys can filter on their own, and an increase in edema. Patients are prone to pneumonia, pericarditis, inflammation of the peritoneum, damage to the mucous membranes of the upper respiratory tract and digestive tract.

How to detect renal artery stenosis?

Examination of a patient with suspected stenosis of the left or right renal artery begins with a detailed clarification of complaints, the time of their occurrence, the response to conservative treatment of hypertension, if it has already been prescribed. Next, the doctor will listen to the heart and large vessels, prescribe blood and urine tests and additional instrumental examinations.

stenosis of both renal arteries on angiographic image

During the initial examination, it is already possible to detect an expansion of the heart due to hypertrophy of the left sections, an increase in the second tone above the aorta. AT upper divisions a murmur is heard in the abdomen, indicating narrowing of the renal arteries.

The main biochemical indicators in SPA will be the level of creatinine and urea, which increase due to insufficient filtration capacity of the kidneys. In the urine, erythrocytes, leukocytes, and protein casts can be detected.

From additional methods diagnostics, ultrasound is used (the kidneys are reduced in size), and dopplerometry allows you to fix the narrowing of the artery and a change in the speed of blood movement through it. Information about the size, location, functional abilities can be obtained by radioisotope research.

Arteriography is recognized as the most informative diagnostic method, when localization, the degree of VA stenosis and hemodynamic disturbance are determined using contrast radiography. CT and MRI may also be performed.

Treatment of renal artery stenosis

Before starting treatment, the doctor will recommend that the patient give up bad habits, start a diet with reduced salt intake, limit fluids, fats and easily accessible carbohydrates. In atherosclerosis with obesity, weight loss is necessary, since obesity can create additional difficulties in planning surgical intervention.

Conservative therapy for renal artery stenosis is of an auxiliary nature, it does not eliminate the root cause of the disease. At the same time, patients need correction of blood pressure and urination. Long-term therapy is indicated for the elderly and people with widespread atherosclerotic vascular disease, including coronary.

Since symptomatic hypertension becomes the main manifestation of renal artery stenosis, treatment is aimed primarily at lowering blood pressure. For this purpose, diuretics and antihypertensive drugs are prescribed. It should be borne in mind that with a strong narrowing of the lumen of the renal artery, a decrease in pressure to normal numbers contributes to the aggravation of ischemia, because in this case even less blood will flow to the parenchyma of the organ. Ischemia will cause the progression of sclerotic and dystrophic processes in the tubules and glomeruli.

The drugs of choice for hypertension against the background of VA stenosis are ACE inhibitors (capropril), however, with atherosclerotic vasoconstriction, they are contraindicated, including for people with congestive heart failure and diabetes, so are replaced by:

Cardioselective beta-blockers (atenolol, egilok, bisoprolol); Blockers of slow calcium channels (verapamil, nifedipine, diltiazem); Alpha-blockers (prazosin); Loop diuretics (furosemide); Imidazoline receptor agonists (moxonidine).

Doses medicines are selected individually, while it is desirable to prevent a sharp decrease in pressure, and when choosing the correct dosage of the drug, the level of creatinine and potassium in the blood is controlled.

Patients with atherosclerotic stenosis need to be prescribed statins to correct lipid metabolism disorders; in diabetes, lipid-lowering agents or insulin are indicated. In order to prevent thrombotic complications, aspirin, clopidogrel are used. In all cases, the dosage of drugs is selected taking into account the filtration capacity of the kidneys.

In severe renal failure against the background of atherosclerotic nephrosclerosis, patients are prescribed hemodialysis or peritoneal dialysis on an outpatient basis.

Conservative treatment often does not give the desired effect, because stenosis cannot be eliminated with drugs, so the main and most effective measure can only be surgery, the indications for which are:

Stenosis of a pronounced degree, causing a violation of hemodynamics in the kidney; Narrowing of the artery in the presence of a single kidney; malignant hypertension; Chronic organ failure with damage to one of the arteries; Complications (pulmonary edema, unstable angina).

Types of interventions used in SPA:

Stenting and balloon angioplasty; Shunting; Resection and prosthetics of a section of the renal artery; Kidney removal;

angioplasty and VA stenting

Transplantation.

Stenting consists in installing a special tube made of synthetic materials into the lumen of the renal artery, which is strengthened at the site of stenosis and allows for blood flow to be established. In balloon angioplasty, a special balloon is inserted through the femoral artery through the catheter, which inflates in the stenosis zone and thereby expands it.

Video: angioplasty and stenting - a minimally invasive way to treat SPA

With atherosclerosis of the renal vessels best effect will give a shunt, when the renal artery is sutured to the aorta, excluding the site of stenosis from the bloodstream. It is possible to remove a portion of the vessel and then replace it with the patient's own vessels or synthetic materials.

A) Prosthetics of the renal artery and B) Bilateral VA shunting with a synthetic prosthesis

If it is impossible to perform reconstructive interventions and the development of atrophy and sclerosis of the kidney, removal of the organ (nephrectomy) is indicated, which is performed in 15-20% of cases of pathology. If stenosis is caused congenital causes, then the question of the need for kidney transplantation is considered, while such treatment is not carried out with vascular atherosclerosis.

AT postoperative period possible complications in the form of bleeding and thrombosis in the area of anastomoses or stents. Recovery acceptable level blood pressure may require up to six months, during which conservative antihypertensive therapy continues.

The prognosis of the disease is determined by the degree of stenosis, the nature of secondary changes in the kidneys, the effectiveness and the possibility of surgical correction of the pathology. With atherosclerosis, slightly more than half of patients return to normal blood pressure after surgery, and in the case of vascular dysplasia surgery allows it to be restored in 80% of patients.

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Renal artery stenosis (RAS) is a fairly common disease that affects older men and women over 30 years of age. Why is that? The answer is ambiguous, but assumptions about such a development of events modern medicine provides.

Let us consider in detail what is renal artery stenosis, what types of this pathology are known. Causes of the disease and the most common symptoms. Modern methods treatment of pathology, including folk methods.

What is a spa and how does it work

Renal artery stenosis is a nephropathic disease. It is caused by stenosis (narrowing) or final blockage (occlusion) of the arteries leading to the kidneys.

This disease can affect one or both kidneys. Unilateral pathology causes circulatory disorders in one organ, but both suffer, since the second (healthy) kidney is subjected to increased stress.

Bilateral, or bilateral, stenosis is a very serious disease, since the functions of the paired organ are impaired and it is almost impossible to compensate for them. Patients with this pathology are often forced to regularly carry out such a procedure as hemodialysis - blood purification through the "artificial kidney" apparatus.

There are two types of stenosis, which differ in the localization of damage to the arteries:

Atherosclerotic - accounts for up to 90% of cases of this disease and is typical for the older age group, mainly in the male population. General vascular atherosclerosis, caused by various factors, affects the arteries throughout the body, including the kidney ones. The highest risk group includes patients with diabetes mellitus and iliac artery disease, aortic dysfunction and hypertension. It is this type of stenosis that is predicted to be the most unfavorable and requires hemodialysis in especially severe cases. Pathological narrowing is observed at the mouth of the arteries leading to the kidneys. Fibromuscular dysplasia - the lesion is localized in the middle and distal parts of the arteries. This is a rather rare type of pathological process that is typical for the fair sex aged 15 to 50 years. The exact causes of this pathology have not yet been established.

Renal stenosis may be congenital. This is a consequence of intrauterine infections, pathological pregnancy or genetic predisposition. In this case, treatment begins immediately. In severe cases, a kidney transplant is required.

Causes and symptoms

Renal vascular stenosis refers to vascular disease. He is treated not only by a nephrologist, but also by a cardiologist and a vascular surgeon.

Often, determining the causes of this pathology can help prescribe the right therapy or surgical treatment:

Atherosclerosis is the most common and likely cause of stenosis in older patients. Moreover, men over the age of 50 suffer from this disease 2 times more often than women. Fibromuscular dysplasia are mainly congenital defects in the vascular walls, leading over time to their spasm and the development of renal stenosis.

Heredity is one of possible factors development of vascular pathologies, including renal. Acute diseases kidney or often recurrent chronic pathologies. Obesity or an increased body mass index, which are characteristic of some endocrine pathologies - in particular, diabetes mellitus. An increased concentration of cholesterol in the blood, which provokes the risk of developing atherosclerosis and the formation of cholesterol plaques on the walls of blood vessels. Bad habits - smoking, drinking alcohol, even weak (but regularly and often). Hypertension. This disease is generally very "interesting" in connection with stenosis of the renal arteries. By itself, it is the cause of the development of pathology of the renal vessels, but it is also a consequence of stenosis. The so-called "renal pressure" is one of the most uncontrolled and difficult to correct types of high blood pressure.

Renal artery stenosis in terms of symptoms is not a specific disease. Each patient, depending on the cause of this pathology, may develop "their" symptoms.

But the general clinical picture something like this:

BP jumps. Its performance can reach 220-250 / 140-170 mm Hg. Art. Moreover, antihypertensive drugs give a short-term effect; frequent headaches with dizziness, accompanied by "flies" before the eyes, as well as tinnitus; blurred vision, especially with high blood pressure. There is a painful feeling in eyeballs; general weakness, sudden mood swings, deterioration in concentration and memory, insomnia at night and drowsiness during the day; chest pain radiating to the projection of the heart and left hand. This symptom is especially characteristic if there is stenosis of the left renal artery; tachycardia, accompanied by shortness of breath even at rest; pain in the lower back in the projection of the kidneys, which are aching and pulling in nature; when conducting a urine test, a small amount of protein is detected.

One of the characteristic signs of renal artery stenosis can be called a significant discrepancy between blood pressure indicators on the right and left hands.

Treatment

The main and most dangerous symptom of renal artery stenosis is an increase in blood pressure. All therapeutic measures will be directed mainly to the expansion of this particular problem. However, renal artery stenosis, in the treatment of which only conservative therapy is used, remains as a pathology. After all, the cause itself has not been eliminated - the narrowing of the vessel that feeds an important organ of the human body.

With this pathology, it is recommended to treat high blood pressure with the following drugs:

beta-blockers of cardioselective action - Atenolol, Bisoprolol and others; calcium channel blockers - Verapamil, Nifedipine and others; blockers; diuretic drugs.

What kind of drug will be prescribed, its dosage and regularity of administration will be determined by a specialist after a number of studies. However, surgery will get rid of the problem itself, and there will be no need to carry out symptomatic treatment, at least in such doses of drugs and with such intensity.

Determination of tactics of surgical treatment is carried out in each case after determining the stage of stenosis, the general condition of the patient, his age and the presence of contraindications.

Bilateral renal artery stenosis implies an indispensable operation to restore the function of at least one organ. Otherwise, the patient will be doomed to carry out hemodialysis for the rest of his life. After all, the kidneys filter the blood and remove toxins that are formed in the process of life. If filtration is not carried out forcibly during stenosis, then poisoning of the body will inevitably occur, which will lead to death.

Surgery is carried out in several ways:

Shunting - the creation of "bypass" paths for blood flow in the kidney. Angioplasty - the introduction of a special balloon that inflates inside the affected vessel and restores the lumen. Stenting - the introduction of a spring stent to maintain the vessel in an "open" state, for the unhindered passage of blood. Resection followed by prosthetics. The damaged section of the artery is removed and reconstruction is carried out using an implant. Nephrectomy - removal of a damaged organ. Such an operation is performed only in extreme cases with significant damage to the organ and the ineffectiveness of another type of intervention.

Traditional medicine can offer its own recipes for treatment, but rather pressure, and not stenosis as such. These methods will be effective in case of a slightly pronounced process of damage to the renal arteries, when the functions of the kidneys did not suffer and their sizes did not change - that is, at the very initial stages of the disease.

Rosehip infusion with hawthorn will have a slight diuretic effect, cleanse the vessels, strengthen their walls and increase immunity.

For cooking you will need:

4 tbsp. l. rosehip, 8 tbsp. l. hawthorn; 2 liters of boiling water.

Plant raw materials pour boiling water in a thermos and leave for 6 hours. Take a glass three times a day, preferably before meals.

A decoction of rowan bark has a similar effect.

For cooking you need:

100 g of rowan bark; one and a half glasses of water.

In an enamel saucepan, bring water to a boil, add the bark and simmer over very low heat for about 2 hours. Then the broth is cooled, filtered and squeezed. Keep the liquid in the refrigerator, take 3 tbsp. l. before meals two to three times a day - depending on the pressure indicators.

Pathology of the vessels of the kidneys is a serious disease. You do not need to ignore even the slightest symptoms in order to start treatment on time.

May 12, 2017 Vrach

The renal artery supplies the kidney with blood, enabling it to do its job. It has features due to its functions. If there are problems with this vessel, then the normal functioning of the kidney is inevitably disrupted.

There are two renal arteries in our body, and each of them is divided into two large and several small branches. Ultimately, a vascular network is created. From it, smaller arterial vessels depart to the renal capsule and carry blood to the pyramids of the kidney. Further, the afferent vessels are divided into tangles of capillaries, which are covered by the glomeruli and tubules of the organ. The efferent arteries also break up into capillaries, which braid the tubules and pass into the veins.

The right artery is longer than the left, it comes from the aorta behind the inferior vena cava.

Pathologies

Pathological changes in the arteries of the kidneys can be congenital or acquired for various reasons. Congenital vascular anomalies are usually associated with abnormalities in the development of the kidneys. Defects mainly accompany tissue dysplasia, dystopia or duplication of renal structures. All these pathologies develop during the prenatal period and are due to adverse effects on a woman during pregnancy or her diseases. The kidneys of a child are formed throughout the prenatal period, so they are subject to any negative impact.

Of the acquired pathologies, it should be noted that stenosis is the most common. Atherosclerotic changes, aneurysm formation, thrombosis, dysplasia of its tissues are also possible.

Diagnostic studies

Auscultation.
Dopplerography.
Arteriography.

The simplest and most accessible diagnostic method is auscultation, that is, listening to the renal arteries. It is carried out using a conventional phonendoscope, which is installed above the site of the vessel. If the blood flow passes freely, then no noises and tones are heard. If there is narrowing or obstruction of the blood flow, the doctor will hear a systolic murmur.

The most voluminous and informative study can be called dopplerography. This is duplex scanning, which makes it possible to assess the state of not only the tissues of the vessel, but the blood flow in it. According to the results this study it is possible to determine the degree of elasticity of tissues, the thickness and structure of the vascular wall, its integrity, the presence of formations in the lumen of the artery, as well as hemodynamic disturbances and their severity. The whole procedure takes no more than half an hour.

What is stenosis

Stenosis is a partial occlusion, that is, a narrowing of the lumen of the artery itself or one of its main branches. The reasons may be:

inflammatory process;
tumor formations;
atherosclerotic changes;
fibromuscular dysplasia.

The stenosis may be due to a tumor. When the neoplasm reaches a certain size, it presses on the vessel, and its lumen decreases. Occlusion can occur due to thickening of the internal vascular membranes. Such thickening is caused by inflammatory or atherosclerotic processes.

One of the causes of persistent, difficult to eliminate hypertension, which occurs as a consequence of renal artery stenosis, is fibromuscular dysplasia. It is a lesion of the tissues of the vascular wall, which leads to the formation of vessel constrictions and disruption of normal blood flow.

Stenosis is often asymptomatic, but prolonged narrowing of the lumen of the vessel disrupts the trophism of the kidney and inevitably affects its work. The main manifestations of stenosis are renal failure and a sharp increase in blood pressure. Prolonged course of pathology can lead to azotemia. This disease is manifested by symptoms such as excessive fatigue, weakness, and possible confusion.

In treatment, first of all, attention is paid to lowering blood pressure. For this, it is applied drug therapy and surgical methods. Stenting and balloon angioplasty are effective.

A stable effect in terms of normalizing blood pressure is given by catheter denervation. What is this procedure? Using a catheter, a special device is inserted through a large femoral vessel, which performs radiofrequency cauterization of certain areas of the kidney arteries. This leads to the interruption of nerve impulses, as a result of which the kidneys no longer have such a big effect on blood pressure indicators.

Aneurysm of the kidney vessels

An aneurysm is a protrusion of the tissues of the vessel wall due to its stretching, decrease in tone or damage. A small aneurysm may cause no symptoms, but narrowing of the lumen impairs blood flow, leading to hypertension. In addition, thromboembolism is possible, since erythrocytes accumulate at the site of the obstacle with increased clotting rates.

Treatment of this pathology is only surgical. Today, various methods are used for this.

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What is thrombosis and why is it dangerous

Thrombosis occurs when a large renal vessel is blocked by a thrombus. Such a condition can be a consequence of atherosclerosis, and trauma or an inflammatory process can provoke the separation of a blood clot. With thrombosis, acute pain occurs in the kidney area, which can spread to the abdomen, give to the side. Violation of the blood supply to the kidney is accompanied by an increase in blood pressure, nausea and vomiting are possible.

Treatment depends on the degree of arterial occlusion. A set of measures is usually applied, which include symptomatic and anticoagulant treatment. In cases where immediate assistance is required, surgery is indicated.

Since the renal artery is a large vessel that plays a strategic role in the function of the kidney, any problems that arise in it are dangerous. Do not postpone the diagnosis, you should consult a doctor at the first symptoms of trouble in the area urinary tract.

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The structure of the vessels of the kidney

The renal arteries arise from the abdominal aorta just below the superior mesenteric artery, at the level of the second lumbar vertebra. Anterior to the renal artery is the renal vein. At the hilum of the kidney, both vessels are anterior to the pelvis.

The PAP passes behind the inferior vena cava. The LPV passes through the "tweezers" between the aorta and the superior mesenteric artery. Sometimes there is an annular PV, then one branch is located in front, and the other - behind the aorta.

Click on pictures to enlarge.

To study the vessels of the kidney, a convex probe of 2.5-7 MHz is used. The position of the patient is lying on his back, the sensor is placed in the epigastrium. Assess the aorta from the celiac trunk to the bifurcation in B-mode and color flow. Follow the course of the RAA and LAA from the aorta to the hilum of the kidney.

Picture. In the CFM mode, on the longitudinal (1) and transverse (2) sections, the RSA and LSA depart from the aorta. Vessels are sent to the gates of the kidney. Anterior to the renal artery is the renal vein (3).

Picture. The renal veins drain into the inferior vena cava (1, 2). Aortomesenteric "tweezers" can compress the LPV (3).

Picture. At the hilum of the kidney, the main renal artery divides into five segmental ones: posterior, apical, superior, middle, and inferior. Segmental arteries are divided into interlobar arteries, which are located between the pyramids of the kidney. Interlobar arteries continue into arcuate → interlobular → glomerular afferent arterioles → capillary glomeruli. Blood flows from the glomerulus through the efferent arteriole into the interlobular veins. The interlobular veins continue into the arcuate → interlobar → segmental → main renal vein → inferior vena cava.

Picture. Normally, with CDI, the vessels of the kidneys can be traced to the capsule (1, 2, 3). The main renal artery enters through the renal hilum, accessory arteries from the aorta or iliac artery may enter at the poles (2).

Picture. On ultrasound, a healthy kidney shows linear hyperechoic structures along the base of the pyramids (corticomedullary junction) with a hypoechoic path in the center. These are arcuate arteries, which are mistakenly regarded as nephrocalcinosis or stones.

Video. Arcuate arteries of the kidney on ultrasound

Doppler of kidney vessels is normal

The diameter of the renal artery in adults is normally 5 to 10 mm. If diameter<4,65 мм, вероятно наличие дополнительной почечной артерии. При диаметре главной почечной артерии <4,15 мм, дополнительная почечная артерия имеется почти всегда.

The renal artery should be assessed at seven points: at the exit from the aorta, in the proximal, middle and distal segments, as well as the apical, middle and inferior segmental arteries. We evaluate peak systolic (PSV) and end-diastolic (EDV) blood flow velocity, resistivity index (RI), acceleration time (AT), acceleration index (PSV/AT). See more.

The normal spectrum of the renal arteries has a pronounced systolic peak with antegrade diastolic flow throughout the cardiac cycle. In adults, PSV is normal on the main renal artery 100±20 cm/sec, EDV is 25-50 cm/sec, in young children PSV is 40-90 cm/sec. In the segmental arteries, PSV drops to 30 cm/sec, in the interlobar arteries to 25 cm/sec, in the arcuate arteries to 15 cm/sec, and in the interlobular arteries to 10 cm/sec. RI at the hilum of the kidney<0,8, RI на внутрипочечных артериях 0,34-0,74. У новорожденного RI на внутрипочечных артериях достигает 0,8-0,85, к 1 месяцу опускается до 0,75-0,79, к 1 году до 0,7, у подростков 0,58-0,6. В норме PI 1,2-1,5; S/D 1,8-3.

Picture. Normal spectrum of renal arteries - high systolic peak, antegrade diastolic flow, low peripheral resistance - RI normal<0,8.

Picture. The spectrum of renal vessels in newborns: renal artery - a pronounced systolic peak and antegrade diastolic flow (1); high resistance on the intrarenal arteries is considered normal for newborns - RI 0.88 (2); renal vein - antegrade flow with a constant rate throughout the entire cardiac cycle, minimal respiratory fluctuations (3).

Doppler for renal artery stenosis

Renal artery stenosis can be found in atherosclerosis or fibromuscular dysplasia. With atherosclerosis, the proximal segment of the renal artery is more likely to suffer, and with fibromuscular dysplasia, the middle and distal segments are more likely to suffer.

Direct signs of renal artery stenosis

The aliasing indicates the location of the turbulent high-velocity flow where measurements should be taken. In the zone of stenosis PSV>180 cm/sec. In young people, the aorta and its branches may normally have high PSV (>180 cm/sec), and in patients with heart failure, PSV is low even in the area of stenosis. These features are offset by the renal-aortic RAR ratio (PSV in the area of stenosis/PSV in the abdominal aorta). RAR in renal artery stenosis >3.5.

Indirect signs of renal artery stenosis

Direct criteria are preferred; diagnosis should not be based solely on circumstantial evidence. In the post-stenotic section, the flow fades - tardus-parvus effect. With renal artery stenosis on the intrarenal arteries, PSV is too late (tardus) and too small (parvus) - AT > 70 ms, PSV / AT<300 см/сек². Настораживает значительная разница между двумя почками — RI >0.05 and PI >0.12.

Table. Criteria for renal artery stenosis on ultrasound

Picture. A 60-year-old female patient with refractory arterial hypertension. PSV on the abdominal aorta 59 cm/sec. In the proximal part of the RA with CDI aliasing (1), PSV is significantly increased 366 cm/sec (2), RAR 6.2. In the middle segment of the PPA with color flow aliasing, PSV 193 cm/sec (3), RAR 3.2. On segmental arteries without a significant increase in acceleration time: upper - 47 ms, middle - 93 ms, lower - 33 ms. Conclusion:

Picture. A patient with acute renal failure and refractory arterial hypertension. Ultrasound of the abdominal aorta and renal arteries is difficult due to intestinal gas. On the segmental arteries on the left RI 0.68 (1), on the right RI 0.52 (2), the difference is 0.16. The spectrum of the right segmental artery has the shape of a tardus-parvus - the acceleration time is increased, PSV is low, the apex is rounded. Conclusion: Indirect signs of stenosis of the right renal artery. CT angiography confirmed the diagnosis: at the mouth of the right renal artery, atherosclerotic plaques with calcification, moderate stenosis.

Picture. Patient with arterial hypertension. PSV in the aorta 88.6 cm/sec (1). In the proximal RAP, aliasing, PSV 452 cm/sec, RAR 5.1 (2). PPA aliasing in the middle section, PSV 385 cm/sec, RAR 4.3 (3). In the distal part of the PPA, PSV is 83 cm/sec (4). On the intrarenal vessels of the tardus-parvus, the effect is not determined, on the right RI 0.62 (5), on the left RI 0.71 (6), the difference is 0.09. Conclusion: Stenosis in the proximal section of the right renal artery.

Doppler of the renal veins

The left renal vein runs between the aorta and the superior mesenteric artery. Aortomesenteric "tweezers" can compress the vein, leading to venous renal hypertension. In the standing position, the “tweezers” are compressed, and in the prone position, they open. With Nutcracker syndrome, outflow through the left testicular vein is difficult. This is a risk factor for the development of left-sided varicocele.

Due to compression, the LPV spectrum is similar to the portal vein - the spectrum is higher than the baseline, the constant low speed, the contour is smooth waves. If the ratio of the diameter of the LPV in front of and in the zone of narrowing is more than 5 or the flow rate is less than 10 cm/sec, we make a conclusion about an increase in venous pressure in the left kidney.

Task. On ultrasound, the left renal vein is dilated (13 mm), the area between the aorta and the superior mesenteric artery is narrowed (1 mm). Blood flow in the stenosis zone at high speed (320 cm/sec), reverse of blood flow in the proximal segment. Conclusion: Compression of the left renal vein with aortomesenteric "tweezers" (Nutcracker syndrome).

Compression of the renal vein is possible due to an abnormal location behind the aorta. The diameter ratio and flow rate are evaluated according to the above rules.

The nature of the blood flow in the right renal vein approaches the caval. The shape of the curve changes with holding the breath and can be flatter. The blood flow velocity is 15-30 cm/sec.

Take care of yourself, Your Diagnostician!

What diseases affect the renal artery

How is the renal artery arranged?

There are two renal arteries in our body, and each of them is divided into two large and several small branches. Ultimately, a vascular network is created.

From it, smaller arterial vessels depart to the renal capsule and carry blood to the pyramids of the kidney. Further, the afferent vessels are divided into tangles of capillaries, which are covered by the glomeruli and tubules of the organ.

The efferent arteries also break up into capillaries, which braid the tubules and pass into the veins.

The right artery is longer than the left, it comes from the aorta behind the inferior vena cava.

Pathologies

Defects mainly accompany tissue dysplasia, dystopia or duplication of renal structures. All these pathologies develop during the prenatal period and are due to adverse effects on a woman during pregnancy or her diseases.

The kidneys of a child are formed throughout the prenatal period, so they are subject to any negative impact.

Of the acquired pathologies, it should be noted that stenosis is the most common. Atherosclerotic changes, aneurysm formation, thrombosis, dysplasia of its tissues are also possible.

Diagnostic studies

Auscultation.
CT scan.
Dopplerography.
Arteriography.

The simplest and most accessible diagnostic method is auscultation, that is, listening to the renal arteries.

It is carried out using a conventional phonendoscope, which is installed above the site of the vessel. If the blood flow passes freely, then no noises and tones are heard.

If there is narrowing or obstruction of the blood flow, the doctor will hear a systolic murmur.

Dopplerography can be called the most voluminous and informative study. This is a duplex scan, which makes it possible to assess the state of not only the tissues of the vessel, but the blood flow in it.

Based on the results of this study, it is possible to determine the degree of tissue elasticity, the thickness and structure of the vascular wall, its integrity, the presence of formations in the lumen of the artery, as well as hemodynamic disorders and their severity.

The whole procedure takes no more than half an hour.

What is stenosis

Stenosis is a partial occlusion, that is, a narrowing of the lumen of the artery itself or one of its main branches. The reasons may be:

inflammatory process;
tumor formations;
atherosclerotic changes;
fibromuscular dysplasia.

One of the causes of persistent intractable hypertension that occurs as a consequence of renal artery stenosis is fibromuscular dysplasia. It is a lesion of the tissues of the vascular wall, which leads to the formation of vessel constrictions and disruption of normal blood flow.

Stenosis is often asymptomatic, but prolonged narrowing of the lumen of the vessel disrupts the trophism of the kidney and inevitably affects its work.

The main manifestations of stenosis are renal failure and a sharp increase in blood pressure. Prolonged course of pathology can lead to azotemia.

This disease is manifested by symptoms such as excessive fatigue, weakness, and possible confusion.

In treatment, first of all, attention is paid to lowering blood pressure. For this, drug therapy and surgical methods are used. Stenting and balloon angioplasty are effective.

A stable effect in terms of normalizing blood pressure is given by catheter denervation.

What is this procedure? Using a catheter, a special device is inserted through a large femoral vessel, which performs radiofrequency cauterization of certain areas of the kidney arteries.

This leads to the interruption of nerve impulses, as a result of which the kidneys no longer have such a big effect on blood pressure indicators.

Aneurysm of the kidney vessels

An aneurysm is a protrusion of the tissues of the vessel wall due to its stretching, decrease in tone or damage. A small aneurysm may cause no symptoms, but the narrowing of the lumen impairs blood flow, leading to hypertension. In addition, thromboembolism is possible, since erythrocytes accumulate at the site of the obstacle with increased clotting rates.

Treatment of this pathology is only surgical. Today, various methods are used for this.

What is thrombosis and why is it dangerous

With thrombosis, acute pain occurs in the kidney area, which can spread to the abdomen, give to the side.

Violation of the blood supply to the kidney is accompanied by an increase in blood pressure, nausea and vomiting are possible.

Treatment depends on the degree of arterial occlusion. A set of measures is usually applied, which include symptomatic and anticoagulant treatment. In cases where immediate assistance is required, surgery is indicated.

Since the renal artery is a large vessel that plays a strategic role in the function of the kidney, any problems that arise in it are dangerous. You should not postpone the diagnosis, you should consult a doctor at the first symptoms of trouble in the urinary tract.

Source: https://beregipochki.ru/anatomiya/pochechnaya-arteriya.html

Renal artery: structure, functions, possible pathologies

Human kidneys perform their functions constantly and without interruption. Their functions for the body are priceless. function - cleansing the blood of toxic substances, is performed around the clock. The structure of the renal system is complex, each individual organ performs its own functions. The renal artery delivers blood to the kidneys. This pair blood vessel Supplies medullary substance and cortical substance.

Features and functions

There are two renal arteries. Both normally work in the same way and each supplies blood to the right and left, respectively, there is a left renal artery and a right one. They originate from the abdominal aorta. Their length is small.

Both are divided into a number of smaller ones. All segmental branches are subdivided into interlobar branches, which consist of arcuate arteries.

In turn, they are distributed to the capillaries, which pass into the renal arteries and veins.

The accessory renal artery is a very common ailment, in which case the blood supply comes from the accessory artery. Additional ones are smaller in diameter than the main ones.

If there is a gradual narrowing or complete blockage of the lumen, then the functional work of the renal system deteriorates. Such pathologies can lead to kidney failure or an increase in blood pressure. All changes in the renal arteries must be monitored to rule out more serious pathologies.

The peculiarity of the renal blood flow is its abundance, in relation to other blood supply systems in the body. Also, the blood supply to the kidney has the property of self-regulation.

When the pressure increases, the muscular system contracts, while the blood enters in much smaller volumes, which leads to a decrease in pressure. With a strong decrease in pressure, the vessels dilate and the pressure rises.

In the glomerular system, the pressure is at a constant level.

In order for the maximum amount of toxic substances to be removed, the entire blood flow passes through the system in just 5 minutes. Blood circulation and the condition of the renal arteries are very important to maintain in a healthy form, as they are extremely important for a person. If the renal arteries do not function fully, then the work of the kidneys will deteriorate, which means general state body will be at risk.

Blockage of the renal artery

The narrowing of the renal arteries can occur immediately with two or with one. As a rule, the course of the disease is not rapid. The appearance of blockage of the main veins, or any of their branches, is very dangerous. It happens with a blood clot.

The blood clot travels through the bloodstream from anywhere in the body and stops in the renal artery, resulting in a complete occlusion of the lumen. Most often, blood clots break off from larger ones that form in the heart or in the aorta.

Damage to the walls directly can lead to the formation of a blood clot, which subsequently affects the blockage.

Damage can occur as a result of surgery or after an antiography or angioplasty procedure. Under the influence of atherosclerosis, the vessels are gradually destroyed and clots are formed.

The arteries are also destroyed by a slow-forming enlargement called an aneurysm.

Damage to the renal artery leads to blockage, however, in addition to blockage, rupture of the walls can also occur, so pathologies that can lead to the appearance of clots must be eliminated immediately after detection.

If a blood clot does not form, some pathologies can lead to a significant narrowing, which will reduce the nutrition of the kidneys.

A disease in which there is a narrowing of the walls, but a clot does not form, is called stenosis.

Renal artery stenosis

Renal artery stenosis dangerous pathology. Stenosis is essentially a narrowing of the diameter of blood vessels. In normal functioning, blood filtration leads to the formation of primary urine. With the narrowing of the walls, the volume of blood decreases, the stronger the narrowing occurs, the less blood is fed to the kidneys. The lack of blood leads to an increase in blood pressure, and the body cleans the blood much worse.

Stenosis of the renal arteries completely disrupts the functioning of the organ.

With a critical decrease in blood volume, as well as poor nutrition for a long time, the kidneys cease to function normally and urine is not formed or excreted.

Stenosis is formed against the background of certain diseases. Atherosclerosis, diabetes mellitus, aneurysm, some inflammatory processes, as well as neoplasms in the renal arteries can provoke stenosis.

In order not to provoke the appearance of stenosis, this disease has an extremely negative effect on the condition of the kidneys, as well as on the general health of a person, there is a risk of very serious illness. If not applied on time medical measures, then stenosis can lead to disruption hormonal background, a decrease in protein levels, swelling and a decrease in secreted fluid, a decrease in the amount of plasma.

Renal arteries of the elderly

The walls of arteries throughout the body tend to thicken with age. The renal arteries thicken more slowly than others. In old age, the thickness of the renal arteries is finally formed. It happens from the moment of birth. If the right renal vein thickened significantly, then such a process is observed in the left and vice versa.

In newborns, the inner shell of the hyperplastic thickening bifurcates into two membranes. With the maturation of the body, the elastic lamina is divided into membranes many times. There is an increase in the number of membranes at the beginning of the arteries, as well as at the site of the first division into two separate branches, then this spreads along the entire perimeter of the bifurcated arteries.

At an older age, changes lead to the appearance of an elastic layer with connective tissue and elastic fibers.

Age-related changes do not always lead to the development of pathological processes in the human body. Thickening occurs in any person and leads to the formation of thick enough walls that can withstand damage.

The simple structure of the blood supply in newborns copes well with small loads and small volumes of blood, but with the growth of the body, all processes become much more complicated, respectively, the thickening of the walls, laid down by nature, is advisable.

Diagnostics of changes

During the examination, the doctor may be based on the collection of anamnesis for the appointment of laboratory or instrumental methods diagnostics. The main symptoms of changes in the state of the renal artery:

Increased blood pressure.
A blood test reveals an increase in red blood cells.
Decrease in urine volume and frequency of urination.

These symptoms are also characteristic of other pathologies, so the diagnosis cannot be based on these symptoms alone.

To study the state of the vessels, a special Doppler device is used, which determines how fast the blood moves through the blood supply system.

Wall stenosis is successfully determined by this method, however, the device may not distinguish between slow blood flow.

The introduction of a contrast agent of iodine composition is typical for radiography, or fluoroscopy, which also successfully determine the condition of the renal artery and possible disorders.

The introduction of gallium during MRI is the most accurate method of conducting research, which will allow you to fully study the state of the entire system, as well as each individual vessel.

With this method, it is possible to identify diseases even in the early stages of occurrence.

Source: http://2pochku.ru/anatomiya/pochechnaya-arteriya.html

Renal artery stenosis (RA): causes, signs, diagnosis, treatment, surgery

Every tenth person suffering from high blood pressure has stenosis of the main renal vessels as the main cause of this condition. Today, more than 20 different changes are already known and described, leading to a narrowing of the renal arteries (RA), an increase in pressure and secondary sclerotic processes in the parenchyma of the organ.

Causes of VA stenosis

The most common causes of narrowing of the renal artery are atherosclerosis and fibromuscular dysplasia of the artery wall. Atherosclerosis accounts for up to 70% of cases, fibromuscular dysplasia accounts for about a third of cases.

Atherosclerosis renal arteries with a narrowing of their lumen is usually found in older men, often with existing coronary heart disease, diabetes, obesity.

Lipid plaques are more often located in the initial segments of the renal vessels, near the aorta, which can also be affected by atherosclerosis, the middle section of the vessels and the branching zone in the parenchyma of the organ are much less often affected.

atherosclerosis (right) and fibromuscular dysplasia (left) are the main causes of VA stenosis

About 5% of SPA is caused by other causes, including inflammation of the vascular walls, aneurysmal expansions, thrombosis and embolism of the arteries of the kidneys, compression by a tumor located outside, Takayasu's disease, prolapse of the kidney. In children, there is an intrauterine developmental disorder of the vascular system with VA stenosis, which manifests itself as hypertension already in childhood.

In violation of the flow of blood through the renal vessels, the activation of the system that regulates the level of blood pressure occurs.

The hormone renin and angiotensin-converting enzyme contribute to the formation of a substance that causes spasm of small arterioles and an increase in peripheral vascular resistance. The result is hypertension.

At the same time, the adrenal glands produce excess aldosterone, under the influence of which fluid and sodium are retained, which also contributes to an increase in pressure.

In addition to the activation of the pressure maintenance system, the disease is accompanied by ischemic changes in the kidney itself. Against the background of a lack of arterial blood, tubular dystrophy occurs, connective tissue grows in the stroma and glomeruli of the organ, which inevitably leads to atrophy and nephrosclerosis over time. The kidney condenses, decreases and is unable to perform the functions assigned to it.

Manifestations of SPA

For a long time, SPA can exist asymptomatically or in the form of benign hypertension. Vivid clinical signs of the disease appear when the vasoconstriction reaches 70%. Among the symptoms, the most common are secondary renal arterial hypertension and signs of disruption of the parenchyma (decreased urine filtration, intoxication with metabolic products).

A persistent increase in pressure, usually without hypertensive crises, in young patients prompts the doctor to think about possible fibromuscular dysplasia, and if the patient has crossed the 50-year mark, atherosclerotic damage to the renal vessels is most likely.

Among the complaints of patients with renal hypertension are noted:

Severe headaches, tinnitus, flashing "flies" before the eyes;
Decreased memory and mental performance;
Weakness;
dizziness;
Insomnia or daytime sleepiness;
Irritability, emotional instability.

At the initial stage of the disease, the work of the kidneys is preserved, but hypertension already appears, which, however, can be treated with drugs.

Subcompensation is characterized by a gradual decrease in kidney function, and in the stage of decompensation, signs of renal failure are clearly visible.

Hypertension in the terminal stage becomes malignant, the pressure reaches its maximum numbers and is not “knocked down” by drugs.

SPA is dangerous not only for its manifestations, but also for complications in the form of cerebral hemorrhages, myocardial infarction, pulmonary edema on the background of hypertension. In most patients, the retina is affected, its detachment and blindness are possible.

Chronic renal failure, as the final stage of the pathology, is accompanied by intoxication with metabolic products, weakness, nausea, headache, a small amount of urine that the kidneys can filter on their own, and an increase in edema. Patients are prone to pneumonia, pericarditis, inflammation of the peritoneum, lesions of the mucous membranes of the upper respiratory tract and digestive tract.

How to detect renal artery stenosis?

stenosis of both renal arteries on angiographic image

During the initial examination, it is already possible to detect an expansion of the heart due to hypertrophy of the left sections, an increase in the second tone above the aorta. A murmur is heard in the upper abdomen, indicating narrowing of the renal arteries.

Of the additional diagnostic methods, ultrasound is used (the kidneys are reduced in size), and dopplerometry allows you to fix the narrowing of the artery and a change in the speed of blood flow through it. Information about the size, location, functional abilities can be obtained by radioisotope research.

Treatment of renal artery stenosis

Before starting treatment, the doctor will recommend that the patient give up bad habits, start a diet with reduced salt intake, limit fluids, fats and easily accessible carbohydrates. In atherosclerosis with obesity, weight loss is necessary, since obesity can create additional difficulties in planning surgical intervention.

It should be borne in mind that with a strong narrowing of the lumen of the renal artery, a decrease in pressure to normal numbers contributes to the aggravation of ischemia, because in this case even less blood will flow to the parenchyma of the organ.

Ischemia will cause the progression of sclerotic and dystrophic processes in the tubules and glomeruli.

Doses of drugs are selected individually, while it is desirable to prevent a sharp decrease in pressure, and when choosing the correct dosage of the drug, the level of creatinine and potassium in the blood is controlled.

In severe renal failure against the background of atherosclerotic nephrosclerosis, patients are prescribed hemodialysis or peritoneal dialysis on an outpatient basis.

Conservative treatment often does not give the desired effect, because stenosis cannot be eliminated with drugs, so the main and most effective measure can only be a surgical operation, the indications for which are:

Stenosis of a pronounced degree, causing a violation of hemodynamics in the kidney;
Narrowing of the artery in the presence of a single kidney;
malignant hypertension;
Chronic organ failure with damage to one of the arteries;
Complications (pulmonary edema, unstable angina).

Types of interventions used in SPA:

Stenting and balloon angioplasty;
Shunting;
Resection and prosthetics of a section of the renal artery;
Kidney removal;
angioplasty and VA stenting
Transplantation.

: angioplasty and stenting - a minimally invasive way to treat SPA

With atherosclerosis of the renal vessels, shunting will give the best effect, when the renal artery is sutured to the aorta, excluding the site of stenosis from the bloodstream. It is possible to remove a portion of the vessel and then replace it with the patient's own vessels or synthetic materials.

A) Prosthetics of the renal artery and B) Bilateral VA shunting with a synthetic prosthesis

If it is impossible to perform reconstructive interventions and the development of atrophy and sclerosis of the kidney, removal of the organ (nephrectomy) is indicated, which is performed in 15-20% of cases of pathology. If the stenosis is caused by congenital causes, then the need for kidney transplantation is considered, while such treatment is not carried out with vascular atherosclerosis.

In the postoperative period, complications are possible in the form of bleeding and thrombosis in the area of anastomoses or stents. Restoration of an acceptable level of blood pressure may require up to six months, during which conservative antihypertensive therapy continues.

The prognosis of the disease is determined by the degree of stenosis, the nature of secondary changes in the kidneys, the effectiveness and the possibility of surgical correction of the pathology. With atherosclerosis, slightly more than half of patients return to normal blood pressure after surgery, and in the case of vascular dysplasia, surgical treatment allows it to be restored in 80% of patients.

Source: http://sosudinfo.ru/arterii-i-veny/stenoz-pochechnoi-arterii/

Accessory artery of the right kidney

Diseases of the urinary system affects approximately 35% of the total population of the globe. Approximately 25-30% is associated with kidney abnormalities. These include: renal artery aneurysms, multiple or double renal arteries, solitary artery, accessory renal artery, fibromuscular stenosis, etc.

Accessory renal artery - what is it?

The accessory renal artery is the most common malformation of the renal vessels. This disease occurs in about 80% of cases in people suffering from kidney disease. An accessory artery is an artery that, along with the main renal artery, supplies blood to the kidney.

With this anomaly, two arteries depart from the kidneys: the main and additional. Additional rushes to the upper or lower segment of the kidney. The diameter of the accessory artery is smaller than the main one.

The anomaly occurs during the period of embryonic development, the cause of such deviations is not known for certain. It is assumed that for unidentified reasons, there is a failure of normal development, as a result of which, the renal artery may double.

Kinds

There are several types of pathologies of the renal vessels - arteries, depending on their number:

Double and multiple. The double accessory artery is rare. The second artery, as a rule, is reduced, and is located in the pelvis in the form of branches on the left or right. Multiple arteries are found in normal and pathological conditions. Depart in the form of small vessels from the kidney. Types of accessory renal artery

Clinical picture

The disease is usually asymptomatic. It appears only when the urinary tract is crossed by an accessory artery.

Due to this crossing, the outflow of urine from the kidneys is difficult, as a result of which the following clinical manifestations occur:

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»Hydronephrosis is a persistent and rapid expansion of the renal pelvis that occurs due to a violation of the outflow of urine. Arterial hypertension - high blood pressure (BP).

The jump in blood pressure occurs due to the patient's fluid content in the body, the vessels narrow, the blood flow becomes difficult, as a result, an increase in pressure occurs. Kidney infarction.

With prolonged hydronephrosis, gradual atrophy of the renal parenchyma occurs, which subsequently leads to a heart attack of the entire kidney. The formation of blood clots and bleeding at the intersection of the accessory artery with the urinary tract.

The kidney increases in size. Blood may be found in the urine, and going to the toilet becomes painful. Patients complain about aching pain in the lower back and high blood pressure.

On palpation develops pain syndrome in the form of attacks of renal colic, pain can also radiate to the ribs, both during physical exertion and at rest.

Diagnostics

The most commonly diagnosed double and multiple renal arteries. With this deviation, the blood supply to the kidney is carried out by two or more equal channels in terms of the caliber of the trunks. The disease is difficult to determine, since similar renal arteries are also observed in a healthy kidney. They do not always organize pathology, but are often combined with other types of pathologies.

Determination of the presence of renal pathologies is carried out using x-ray examination.

To determine special cases of abnormal renal arteries, use:

excretory urography; Lower cavography; Renal phlebography; Aortography.

When a double or multiple renal artery is found in a patient, the obtained pyelograms allow us to detect defects in the filling of the ureter, to notice narrowing and kinks in the passage of the vessel, pyeloctasia.

To determine the anomaly of the solitary artery, aortography is used.

As common methods minimally invasive techniques are widely used: ultrasound renal doppelography, MSCT and

MRI of the kidneys

Treatment

What to do and how to carry out treatment is determined only after a complete diagnosis of the disease. Treatment is based on the restoration of a physiologically normal outflow of urine from the body. This effect can only be achieved by surgery.

Resection of the accessory artery. Removal can be complete or partial. Partial - the removal of the accessory artery and the damaged area is almost carried out. Complete removal - removal of both the accessory artery and the entire kidney.

Resection of the urinary tract. This operation is performed when resection of the accessory artery is not possible. The narrowed portion of the urinary tract is removed and re-sutured.

The method of surgical intervention is determined by the urologist-surgeon individually for each patient.

Deviations in the field of urology are common. One of these disorders is anomalies of the renal arteries. The accessory renal artery is a common type of pathology; it can occur against the background of other renal pathologies, but it can also be independent. The cause of this pathology is the embryonic vascularization of the structure of the organ.

An accessory artery in the kidney is a smaller blood vessel than the main aorta, which may be from the abdominal, renal, celiac, phrenic, or iliac arteries in the direction of the upper or lower edges of the kidneys, or be a process from the main line.

As a result, the blood supply to the kidneys comes from several places at the same time.

With the upper direction of the accessory aortas of the organ, there are no disturbances in the operation of the system. More often, such a pathology opens with an x-ray of the blood vessels of the kidney. Arteries moving down are the main causes of organ dysfunction and are a provoking factor in diseases such as uronephrosis (hydronephrosis), arterial hypertension, hematuria and many others.

The development of additional vessels in the kidneys is a consequence of genetic failures, sometimes occurring together with other pathologies of the genitourinary system.

Symptoms of the presence of accessory renal arteries

The following signs may indicate the presence of an accessory renal artery:

hypertension (increased blood pressure); enlargement, obstruction urinary tract;pain in lumbar regions; urolithiasis; renal nephritis.

Diagnostics

"Extra" renal arteries are detected by a comprehensive hardware examination.

A variety of methods are used to diagnose an accessory renal vessel. Frequent and effective method - ultrasound procedure.To diagnose this anomaly, the Doppler scanner method is used.

With its help, not only a complete picture of the actions inside the right or left kidney is created, but the movement of blood is monitored: its direction and swiftness.

However, with a slow flow of liquid, the device will not detect movement.

For the study of renal vessels, methods using contrast solutions are used. These include:

conventional x-ray examinations; computed radiography; magnetic resonance imaging (MRI); digital subtraction angiography.

Anomaly treatment

After the complete examination the doctor prescribes a specific treatment for each case, based on the data received. The main goal of therapy is to restore a healthy outflow of urine from the kidneys. This is achieved by resection of the kidneys or resection of sclerotically altered areas of the genitourinary tract, using ureterouretero- or ureteropyelostomy.

Do not forget that the diagnosis of "additional renal artery" is dangerous for the body as a whole and its individual systems.

It is necessary to monitor changes in your body, consult a doctor for preventive purposes, and even more so with symptoms such as: pain in the head; a sharp increase in blood pressure; pain in the lumbar; changed color, volume and other visible properties of urine; swelling of the face in the morning. Ignoring them is dangerous to health.

Accessory renal artery

The accessory renal artery is the most common type of anomaly of the renal vessels (84.6% of all detected malformations of the kidneys and upper urinary tract). What is called "accessory renal artery"? In the early works of NA.

Lopatkin wrote: “In order to avoid confusion, it is advisable to call each vessel extending from the aorta in addition to the main renal artery an additional one, and use the term “multiple arteries” when referring to the entire supply of the kidney in such cases.”

In later publications, the term "additional artery" is not used at all, but the term "accessory artery" is used.

Such arteries "have a smaller caliber compared to the main one, go to the upper or lower segment of the kidneys both from the abdominal aorta and from the main trunk of the renal, adrenal, celiac, phrenic or common iliac arteries." There is no clear difference in the interpretation of these concepts. A V Ayvazyan and A.M.

Voyno-Yasenetsky strictly distinguished the concepts of "multiple main", "additional" and "perforating" arteries of the kidney. The "multiple great arteries" originate from the aorta and empty into the renal notch. The source of "additional arteries" are the common and external. celiac, middle adrenal, lumbar arteries. But they all enter through the renal notch.

"Perforating vessels" - penetrating into the kidney outside its gates. Another interpretation of the anomalies in the number of renal arteries we found in Campbell's urology (2002). She has S.B.

Bauer, referring to a large number of works, describes "multiple renal arteries" - that is, more than one main, "abnormal or aberrant", - extending from any arterial vessel other than the aorta and the main renal artery, "accessory" - two or more arterial stem feeding one renal segment.

Thus. we did not find a unified terminological approach to renal vascular anomalies of quantity and therefore, the “additional, or additional, vessel” was considered to be the vessels that feed the kidney, in addition to the main artery and depart from the aorta or any vessel, with the exception of the main artery.

"Aberrant arteries" we called the vessels departing from the renal artery and penetrating into the kidney outside the renal sinus. The accessory renal artery can originate from the aorta, renal, diaphragmatic, adrenal, celiac, iliac vessels and go to the upper or lower segment of the kidney.

There is no difference in the location of additional arteries.

Double and multiple renal arteries

Double and multiple renal arteries - a type of anomaly of the renal vessels in which the kidney receives blood supply from two or more trunks of equal caliber.

Accessory or multiple arteries in the vast majority of cases are found in a normal kidney and do not lead to pathology, but quite often they are combined with other kidney anomalies (dysplastic, doubled, dystopic, horseshoe-shaped kidney, polycystic, etc.).

Solitary renal artery

A solitary renal artery supplying both kidneys is an extremely rare anomaly of the renal vessels.

Dystopia of the place of origin of the renal artery

Location anomalies - an anomaly of the renal vessels, the main criterion in determining the type of kidney dystopia:

lumbar - with a low discharge of the renal artery from the aorta; iliac - when departing from the common iliac artery; pelvic - when leaving the internal iliac artery.

Renal artery aneurysm

An aneurysm of the renal artery is an expansion of the vessel due to the absence of muscle fibers in the vessel wall and the presence of only elastic ones. This anomaly of the renal vessels is quite rare (0.11%). It is usually one-sided.

The aneurysm can be located both extrarenally and intrarenally. It is clinically manifested by arterial hypertension, diagnosed for the first time in adolescence.

May lead to thromboembolism of the renal arteries with the development of renal infarction.

Fibromuscular stenosis

Fibromuscular stenosis is a rare vascular anomaly of the renal vessels (0.025%).

It consists of several successive narrowings in the form of a "string of beads" in the middle or distal third of the renal vessel, resulting from the excessive development of fibrous and muscular tissues in the wall of the renal artery. It may be bilateral.

Manifested in the form of difficult to correct arterial hypertension crisis-free flow. Treatment is operative. The type of operation depends on the prevalence and localization of the defect.

Congenital arteriovenous fistulas

Congenital arteriovenous fistulas are less common (0.02%). They are more often localized in the arcuate and lobular vessels and may be multiple. Manifested by symptoms of venous hypertension (hematuria, proteinuria, varicocele).

Congenital changes in the renal veins

Congenital changes in the renal veins can be divided into anomalies in the number, shape and location, structure.

Anomalies of the right renal vein are mainly associated with doubling or tripling. The left renal vein, in addition to an increase in quantity, may have an anomaly in shape and position.

Accessory renal vein and multiple renal veins, according to some data, occur in 18 and 22% of cases, respectively. Usually accessory renal veins are not combined with accessory vessels. Accessory veins, as well as arteries, can cross with the ureter, disrupting urodynamics and leading to hydronephrotic transformation.

Anomalies in the development of the left renal vein are more common due to the peculiarities of embryogenesis. The right renal vein in the process of embryogenesis practically does not undergo changes.

The left renal vein can pass in front of, behind and around the aorta, not flow into the inferior vena cava (extracaval confluence and congenital absence of the cavitary region).

Structural anomalies include renal vein stenosis. It can be permanent or orthostatic.

The clinical significance of these malformations lies in the fact that with them the development of venous hypertension is possible, and as a result, hematuria, varicocele, menstrual irregularities. The influence of venous anomalies on the risk of developing a kidney tumor has been proven.

Previously, angiography was the "gold standard" for diagnosing renal vascular anomalies, but recently it has become possible to diagnose these defects with less invasive methods - digital subtraction angiography, color Doppler echography, MSCT, MRI.

The renal artery is a paired terminal blood vessel that originates from the lateral surfaces of the abdominal aorta and supplies blood to the kidney. The renal arteries bring blood to the apical (apical), posterior, inferior, and anterior segments of the kidney. Only 10% of the blood goes to the medulla of the kidney, and most (90%) - to the cortex.

The structure of the renal artery

There are right and left renal arteries, each of which divides into posterior and anterior branches, and these in turn divide into segmental branches.

Segmental branches branch into interlobar branches, which break up into a vascular network consisting of arcuate arteries. Interlobular and cortical arteries, as well as medullary branches, from which blood flows to the lobes (pyramids) of the kidney, depart from the arcuate arteries to the renal capsule. All together they form arcs from which the bringing vessels depart. Each afferent vessel branches into a tangle of capillaries enclosed by the glomerular capsule and the base of the renal tubule.

The efferent artery also splits into capillaries. Capillaries braid the tubules of the kidneys, and then pass into the veins.

The right artery from the aorta runs forward and straight, and then goes to the kidney, obliquely and down, behind the inferior vena cava. The path of the left artery to the hilum of the kidney is much shorter. It moves in a horizontal direction and flows into the left kidney behind the left renal vein.

Renal artery stenosis

Stenosis is called partial occlusion of an artery or its main branches. Stenosis develops as a result of inflammation or compression of the artery by a tumor, dysplasia, or atherosclerotic narrowing of the vessel. Fibromuscular dysplasias are a group of lesions in which there is a thickening of the middle, inner, or subadventitial lining of the vessel.

With stenosis of the renal arteries, the functioning of the kidney is disrupted due to its inadequate blood supply. Impaired kidney function often leads to the development of renal failure. Renal artery stenosis sometimes manifests itself in a sharp increase in blood pressure. But most often this disease is asymptomatic. Prolonged stenosis of the arteries can lead to azotemia. Azotemia is manifested in confusion, weakness, fatigue.

The presence of stenosis is usually determined using CT angiography, dopplerography, urophragia, and arteriography. Additionally, to identify the causes of the disease, urinalysis, biochemical and general analyzes blood, determine the concentration of electrolytes.

A combination of antihypertensive drugs is usually prescribed to reduce pressure in stenosis. medicines with diuretics. When narrowing the lumen of the vessel by more than 75%, surgical methods of treatment are used - balloon angioplasty, stenting.

Denervation of the renal arteries

To achieve a stable antihypertensive effect, endovascular surgeons use the method of catheter sympathetic denervation of the renal arteries.

Renal artery denervation is an effective bloodless treatment for resistant hypertension. During the procedure, a catheter is inserted into the patient's femoral artery, which penetrates the arteries. Then, under short-term anesthesia, radiofrequency cauterization of the mouths of the arteries from the inside is performed. Cauterization destroys the connection of the afferent and efferent sympathetic nerves of the arteries with nervous system, which leads to a weakening of the influence of the kidneys on blood pressure indicators. After cauterization, the conductor is removed, and the femoral artery puncture site is closed with a special device.

After denervation, there is a stable decrease in blood pressure by 30–40 mm Hg. Art. throughout the year.

Thrombosis of the renal artery

Thrombosis of the renal artery is the blockage of the renal blood flow by a thrombus detached from the extrarenal vessels. Thrombosis occurs with inflammation, atherosclerosis, trauma. In 20-30% of cases, thrombosis is bilateral.

With thrombosis of the renal artery, acute and strong pain in the loins, kidney, back, which extends into the abdomen and side.

In addition, thrombosis can cause a sudden significant increase in blood pressure. Very often, with thrombosis, nausea, vomiting, constipation, and body temperature rise.

Treatment of thrombosis is complex: anticoagulant treatment and symptomatic therapy, surgical intervention.

Renal artery aneurysm

An aneurysm of the renal artery is a saccular expansion of the lumen of the vessel due to the presence of elastic fibers in its wall and the absence of muscle fibers. The aneurysm is most often unilateral. It can be placed both intrarenally and extrarenally. Clinically, this pathology can be manifested by vascular thromboembolism and arterial hypertension.

With an aneurysm of the renal artery, surgery is indicated. There are 3 types of operation of this type of anomaly:

resection of an artery;
excision of the aneurysm with replacement of its defect with a patch;
aneurysmography - suturing the arterial wall with aneurysm tissues left after preliminary excision of its main part.

Aneurysmography is used for multiple vessel lesions and large aneurysms.

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