Ipertensione nefrovascolare
Table of Contents
Definizione
Con il termine “ipertesione nefrovascolare”viene definita la condizione diipertensione arteriosacausata dall’ischemia renale, la cui eziologia nella maggioranza dei casi è da attribuire a malattia nefrovascolare. L’ipertensione nefrovascolare, tra le cause conosciute di ipertensione, è quella più frequente. L’ipertensione nefrovascolare vieneclassificata in base al meccanismo responsabile dell’ ischemia renale. Nel 90% dei casi la causa di ischemia è lastenosi dell’arteria renalesu base aterosclerotica, nei casi rimanenti è la displasia fibromuscolare dell’arteria renale.E’ caratterizzata dalla lenta progressione delle placche aterosclerotiche che può arrivare fino all’occlusione dell’arteria renale che si accompagna una progressiva compromissione della funzione renale e ad atrofia renale.
Sintomi
IL quadro clinico dell’ipertensione nefrovascolare può comprendere:
- Ipertensione insorta in età giovanile in pazienti senza storia familiare.
- Ipertensione resistente al trattamento farmacologico.
- Rapido peggioramento dell’ipertensione.
Esame obiettivo
L’esame obiettivo è caratterizzato dasoffio addominale mono- o bilaterale,alterazioni del fondo oculareallo stadio III o IV.
Esami strumentali
L’ecografia renaleintegrata da Doppler fornisce informazioni sia morfologiche sia funzionali. Differenze della lunghezza tra i due reni >2 cm sono indicative di stenosi dell’arteria renale.
La scintigrafia renalecon paraminoippurato (PAI) o e con acido dietilenaminopentacetico (DTPA) marcati con99mTc consente di valutare in maniera quantitativa il flusso ematico renale e il filtrato glomerulare rispettivamente.
L’angiografia arteriosacon sottrazione di immagine costituisce la procedura di riferimento per l’identificazione di stenosi dell’arteria renale.
Terapia
Il trattamento dell’ipertensione nefrovascolare è rappresentato dallarivascolarizzazione del rene ischemico mediante angioplastica transluminale percutanea con applicazione di stent. Tale procedura nel corso degli anni ha completamente soppiantato la rivascolarizzazione chirurgica.
La terapia medica si basa sulla somministrazione dicalcio antagonisti,ACE inibitori e AT1-antagonisti.Queste ultime tre classi di farmaci, in caso di stenosi bilaterale dell’arteria renale, possono provocare un rapido deterioramento della funzione renale che è reversibile alla sospensione dei farmaci.
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Alimentazione e stile di vita nell’ipertensione
L’ipertensione considerata un “killer silenzioso” rappresenta un gravissimo fattore di rischio per le malattie cardiovascolari e l’ictus. Per questi motivi si raccomanda di affrontarla tempestivamente
e di intraprendere la terapia giusta su parere del medico.
L’obiettivo primario del trattamento del paziente iperteso è quello di ottenere la massima riduzione del rischio di mortalità e morbilità cardiovascolare a lungo termine. Questo obiettivo richiede il trattamento di tutti fattori di rischio identificabili e reversibili, che comprendono il fumo, la dislipidemia, obesità addominale o il diabete. Un trattamento appropriato (Continua)
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