A very "unjust" hypertensive patient took antihypertensive drugs as prescribed by the doctor, but his blood pressure suddenly soared to 180/110mmHg and he never experienced dizziness, headache, blurred vision, heart palpitations, chest tightness, Common symptoms of high blood pressure such as increased nocturia, why did his blood pressure suddenly become difficult to control?
After detailed examination, the doctor finally discovered that it was an important blood vessel in his body - renal artery stenosis that caused his blood pressure to remain high.
This group of people is not uncommon. About million people have renal artery stenosis in the country.
The kidney is not only an organ for urination and detoxification, but also an endocrine organ, responsible for secreting some hormones. When the renal arteries are narrowed and the kidneys feel ischemia, they will secrete renin, angiotensin, etc., which will constrict peripheral blood vessels and increase blood pressure, thereby improving blood supply.
Renal artery stenosis on the one hand causes insufficient blood supply to the kidneys, that is, insufficient nutrients for the kidneys. On the other hand, renal artery stenosis can also cause blood pressure to increase , which aggravates kidney damage and shrinks the kidneys in terms of form and function. It will also cause the kidneys to go on strike, eventually causing renal failure .
teach you a few methods that you can learn and use:
Listen to periumbilical murmur
Renal artery is mainly distributed around the navel, use stethoscope to listen to murmur around the navel, When there is murmur in the periumbilical blood vessels, it is also accompanied by If you have high blood pressure, you need to be alert to renal artery stenosis.
Sudden rise in blood pressure
Past high blood pressure can be controlled, but if antihypertensive drugs remain unchanged Sudden blood pressure is difficult to control , especially for the elderly.
Normal people's blood pressure fluctuates throughout the day. For example, it will be higher during the day than at night. At the same time, it will increase significantly in stressful and exciting situations. Such increases are often relatively short-lived and will not cause serious consequences.
But if it is a patient with renal artery stenosis, his baseline blood pressure will be significantly elevated. If external factors that cause blood pressure to rise again appear, then such blood pressure will continue to soar and remain high .
Edema
Some patients will show severe edema of both lower limbs and inconvenience in urination. Their legs are so swollen that they dare not wear socks, and their legs are pinched by wide-mouthed socks.
Some patients with severe hypertension have normal left ventricular ejection fraction but have recurrent transient pulmonary hydration swelling, which also suggests the possibility of renal artery stenosis.
renal insufficiency
renal insufficiency that is difficult to explain by other reasons or asymmetric renal atrophy.
These imaging examinations can help us find renal artery stenosis:
①B ultrasound - the simplest, lowest cost, short time, no radiation, suitable for screening for the presence of renal artery stenosis.
②CTA - The accuracy is better than B-ultrasound, it has radiation, and it requires contrast agent .
③ MRI - the accuracy is better than B-ultrasound, no radiation, no contrast agent required, but may be affected by vascular calcification .
④ angiography - is the gold standard for renal artery stenosis examination.
The specific examination needs to be arranged by the doctor based on personal circumstances.
The main cause of renal artery stenosis in the elderly is atherosclerosis. Lipid substances in the blood slowly deposit in the proximal end of the renal artery, forming atherosclerotic plaques. The plaques become larger and larger, blocking the lumen. It squeezes smaller and smaller, eventually forming a stricture.
Atherosclerosis is a systemic disease, so patients with coronary artery stenosis and carotid artery stenosis should be wary of renal artery stenosis ; conversely, patients with renal artery stenosis should also be wary of other blood vessels. narrow.
In short, controlling basic diseases and preventing atherosclerosis are important ways to prevent renal artery stenosis.
Compared with the traditional surgical method of femoral artery puncture and renal artery stent implantation, the radial artery puncture wound is relatively small, and there is no need for bed rest and braking after the operation, which can lead to faster recovery;
Moreover, according to the kidney disease of some patients with renal artery stenosis, Regarding the direction of the artery opening, the radial artery approach has a smoother angle and can be implanted with a surgical stent.
relieves renal artery stenosis, and refractory hypertension caused by stenosis can also be completely cured.
