The narrowing of the renal vessels symptoms. What diseases are striking the renal artery kidney artery and veins

The date: 04.03.2020

renal veins- contain blood purified from liquid products.

Read also

2. What happens to blood in pulmonary alveoli?

3. By arteries or veins, blood blood returns to the heart?

4. Where does blood come from left ventricle?

5. What happens in the capillaries of the bodies?

6. What blood goes to the heart of the organs, by what vessels and in which heart department gets?

4) the speed of blood outflow in them is high;

5) there are valves on their inner walls;

6) walls consist of one layer of flat cells;

7) walls dense, elastic;

8) they are characterized by a slow blood flow rate;

9) are located deep between the satellites;

10) vessels connecting arteries and veins;

Name answers on the necessary numbers please!

How many and what circles circles?

What vessels are called veins?

What vessels are called arteries?

Features of the circulatory system lizards

Why do they relate to cold-blooded animals?

Doperar kidney vessels (lecture on the diagnostic)

Building kidney vessels

The renal arteries depart from the abdominal aorta just below the upper mesenteric artery - at the level of the II lumbar vertebra. Kepende from the renal artery is the renal vein. In the gate of the kidneys, both vessels are Kechadi from Lohanki.

PPa passes behind the lower hollow vein. LPV passes through the "tweezers" between the aorta and the upper mesenteric artery. Sometimes there is a ring-shaped LPV, then one branch is located ahead, and the other is behind the aorta.

Press on the pictures to enlarge.

For the study of kidney vessels, a convex sensor is used 2.5-7 MHz. Patient position lying on the back, the sensor is placed in the epigastrics. Evaluate the aorta from the ventilation barrel to bifurcation in the mode and CDC. Trace the progress of PPA and LPA from the aorta to the goal of the kidney.

Drawing. In the CDC mode on the longitudinal (1) and transverse (2) sections from the aorta, PPA and LPA are departed. Vessels are sent to the goal of the kidneys. Kepened from the renal artery is the renal vein (3).

Drawing. Renal veins fall into the lower hollow vein (1, 2). The aorticerial "tweezers" can squeeze the LDF, which leads to the renal hypertension (3). In the standing position "tweezers" is compressed, and in the lying position - reveals.

Drawing. At the goal of the kidneys, the main renal artery is divided into five segmental: rear, top, upper, middle and lower. Segmentation arteries are divided into interdole arteries that are located between the kidney pyramids. Interdoletic arteries continue to arcuate → interdollach → bringing glomeri arterioles → Capillary girls. Blood from the glorula is moving along the ending arteriol into interdollastic veins. Interlocking veins continue to arcuate → Interdoles → Segmental → Major renal vein → Lower hollow vein.

Drawing. Normally, at the CDC, the kidney vessels are traced to the capsule (1, 2, 3). The main renal artery enters the kidney gate, the addition of the aorta or iliac artery can be approached by poles (2).

Doperar kidney vessels

The diameter of the renal artery in adults is normal from 5 to 10 mm. If diameter<4,65 мм, вероятно наличие дополнительной почечной артерии. Если диаметр почечной артерии <4,15 мм, наличие дополнительной почечной артерии чрезвычайно вероятно.

The renal artery should be assessed in seven points: when leaving the aorta, in the proximal, middle and distal segments, as well as the top, middle and lower segmental artery. We estimate the peak systolic (PSV) and the finite-diastolic (EDV) blood flow velocity, the resistivity index (RI), the acceleration time (AT), the acceleration index (PSV / AT). See Doppler vessels in more detail.

The normal spectrum of renal arteries has a pronounced systolic peak with antegradium diastolic flow throughout the heart cycle. In adults, normal on the main renal artery PSV 100 ± 20 cm / s, EdVSM / s, Ri at the gate 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.

Drawing. The normal spectrum of renal arteries is a high systolic peak, antegrad diastolic flow, low peripheral resistance - Ri normally<0,8.

Drawing. Spectrum of kidney vessels in newborns: renal artery - pronounced systolic peak and antegradine diastolic flow (1); High resistance on intravenous arteries is considered normal for newborns - Ri 0.88 (2); Renal vein is an industry stream with a constant speed throughout the heart cycle, minimum respiratory oscillations (3).

Doppler during renal artery stenosis

Stenosis of the renal artery can be found in atherosclerosis or fibromy dysplasia. In atherosclerosis, the proximal segment of the renal artery suffers more often, and during fibromy dysplasia - medium and distal segments.

Direct signs of renal artery stenosis

Alaising effect indicates the place of a turbulent high-speed flow where measurements should be performed. In the PSV stenosis area\u003e 180 cm / s. In the young on the aorta and its branches, there can be high PSV (\u003e 180 cm / s), and in patients with heart failure PSV, even in the area of \u200b\u200bstenosis. These features level the renal-aortic RAR ratio (PSV in the stenosis zone / PSV in the abdominal aorta). RAR with renal artery stenosis\u003e 3.5.

Indirect signs of renal arterial stenosis

Direct criteria are preferred, the diagnosis should not be based exclusively on indirect signs. In the post -tenotic department, the flow fades - the Tardus-Parvus effect. With the stenosis of the renal artery on intravenous PSV arteries too late (Tardus) and too small (Parvus) - at\u003e 70 ms, PSV / AT<300 см/сек². Настораживает значительная разница между двумя почками - RI >0.05 and pi\u003e 0.12.

Table. Criteria of renal artery stenosis on ultrasound

Drawing. Pattern of 60 years with refractory arterial hypertension. PSV on the abdominal aorta 59 cm / s. In the proximal department of PPA at CDC Elaising (1), PSV is significantly increased 366 cm / s (2), RAR 6.2. In the middle segment of PPA at CDC Elaising, PSV 193 cm / s (3), RAR 3.2. In segmental arteries without a significant increase in acceleration time: upper - 47 ms, average - 93 ms, lower - 33 ms. Conclusion: Stenosis in the proximal department of the right renal artery.

Drawing. Patient with acute renal failure and refractory arterial hypertension. Abdominal aortic ultrasound and renal arteries are difficult due to gas in the intestine. In segmental arteries on the left Ri o, 68 (1), right Ri 0.52 (2), the difference of 0.16. The spectrum of the right segmental artery has the form of the TARDUS-PARVUS - the acceleration time is increased, PSV is low, the top is rounded. Conclusion: indirect signs of stenosis of the right renal artery. KT-angiography confirmed the diagnosis: at the mouth of the right renal artery atherosclerotic plaques with calcification, stenosis of a moderate degree.

Drawing. Patient with arterial hypertension. PSV in the aorta 88.6 cm / s (1). In the proximal department of PPA Elasing, PSV 452 cm / s, RAR 5.1 (2). In the middle department of PPA elaising, PSV 385 cm / s, RAR 4.3 (3). In the distal PPA PSV 83 cm / s (4). On the intravenous vessels, the TARDUS-PARVUS effect is not determined, right Ri 0.62 (5), on the left Ri 0.71 (6), the difference is 0.09. Conclusion: Stenosis in the proximal department of the right renal artery.

Take care of yourself, your diagnostic!

Send a response

Good lecture, perfectly illustrated. Thank.

On the main renal artery in adults Ri<0,8 считается нормой. У новорожденных RI может достигать 0,88. На внутрипочечных артериях в норме большой разброс RI от 0,34 до 0,74, НО разница с обеих почек <0,05.

The diameter of the renal artery trunk is normal?

Normally in an adult diameter of the main renal artery 5-10 mm. If diameter<4,5 мм, ищите добавочные артерии.

When dopplerography, kidney prevents breath, what to do?

Adult ask to delay your breath. Young children learn to work quickly.

Very good illustrated lecture. Thank!

What is RAR right?

RAR on the right is the renal and aortic ratio of the right kidney. Rar \u003d PSV in the stenosis area / PSV in the abdominal aorta. RAR with renal artery stenosis\u003e 3.5.

Why is the resistivity index in the kidney?

Ri on the main renal artery is elevated in the stenosis area. Ri on intravenous vessels is elevated in healthy newborns, as well as in the elderly. Ri increases with kidney parenchyma fibrosis, regardless of the cause. Therefore, to use Ri for differential diagnosis is problematic.

How does ri change in chronic renal failure?

Some authors believe that in diabetic and non-cycle angiopathy, as well as after the kidney transplantation, the increase in Ri correlates with the severity of damage to vessels and interstics. Not very successfully tried to predict the forecast of the disease by RI.

What is the renal arterial resistance index in children?

The arteries from the abdominal segment of the aorta have a high resistance index - from 0.78 to 0.9.

In newborns, PSV children in the aorta may reach doss / sec, in the wallet stem / sec, in the branches of the ventricular barrels / s, in the mesenteric arteries / s. In the older children, PSV in the vessels of this zone can be achieved / s. A significant increase in speed in the vessel may indicate its stenosis.

The patient is very thick, I can not withdraw the main renal arteries. How to be?

In conclusion, specify - "Access is difficult, a study is uninformative." Try to get a spectrum from the intravenous arteries. Indirect sign of renal arterial stenosis TARDUS-PARVUS Effect: AT\u003e 70 ms, ai<300 см/сек². Настораживает значительная разница на внутрипочечных сосудах с обеих почек - RI >0.05 and pi\u003e 0.12.

"I do not know the best medication from asthma ..." Nicholas Calpeper, 1653 Honey Current (L. PericlyMenum) was once widely used in Europe for the treatment of bronchial asthma, urinary disorders and during childbirth. Pliny recommends adding it to wine with spleen diseases. Based on infusion from the honeysuckle flowers (L. PericlyMenum) traditionally make syrup, which is taken as an expectorant with a strong cough [...]

By the middle of summer, Creeps blooms, covered with a pinkish carpet. Large area of \u200b\u200bforest garry and cutting. Flowers and leaves are harvested during flowering, dried in the shade and stored in tightly closed jars, boxes. Cypryet narrow, Ivan tea or Kopor's tea is a famous herbaceous plant with a splashing brush of pink flowers. This is one of the few wild plants that are used in food [...]

"This is one of the most amazing herbs from the Russian Academy of Sciences, the highest and expensive, used as an internal and outdoor drug." Nicholas Calpeger, 1653 His Russian name was obtained due to the festral leaves, resembling the finish of medieval dresses, and its Latin name comes from the word "alchemy", which indicates the miraculous properties of the plant. Collect herb while flowering. Character: Cool, Dry; Taste [...]

"The nature of this plant is so amazing that one touch stops bleeding." Pliny, 77 AD. Horsetail - botanical relic, close to trees that grew on Earth 270 million years ago, in the coal period. In the USSR, 15 types of horsages took place. The greatest practical interest is a field of field (E. Arvense). Horsetail (E. Arvense) - a perennial disputes of herbaceous plant [...]

The ephedra plant (Ma Huang, in Chinese) contains alkaloids - ephedrine, norefedrine and pseudoephedrine. Alkaloids from 0.5 to 3%. In the ephedron of the horsetail and ephedron, the concern more Ephedrine, and in the middle ephed - pseudoephedrine. In the autumn and winter months, the content of alkaloids is maximum. In addition to alkaloids in the ephedron to 10% of tubyl substances and essential oils.

Ephedrine, Norefedrin and pseudoephedrine are similar to adrenaline - stimulate alpha and beta-adrenoreceptors.

This book is designed for beginner fans-ginselodes growing a plant in the household plots, and ginsengovodov who first start working on industrial plantations. The cultivation experience and all the recommendations are given taking into account the climatic features of the non-black earth. Preparing to describe your experience of growing ginseng, I thought for a long time on what to start the presentation of accumulated information, and came to the conclusion that it makes sense to briefly and consistently tell about all the ginselode paths passed by me so that the reader could weigh his strength and opportunities in this time consideration business.

For a murderous drink from worms you need: 3 tablespoons of raw (not fried) Pumpkin seeds, half of a small bulb, 1 teaspoon of honey ,? Glasses of milk, blender.

Dr. Popov about folk remedies against Crohn's disease and nonspecific ulcerative colitis (Nyak): Chronic colitis cure very simple, if an on an empty stomach take a teaspoon of plantain seeds, and in the evening a teaspoon of the seed of horse sorne.

Each spring one of the first appears nettle shoots. Neprug is the first gift of spring. Tea from nettle improves, restore power, raise immunity and awakens the body in the spring.

It's time to get rid of the bleeding of the gums and strengthen the gums. In the spring, a unique grass is growing, which is called Opechaig. If you eat it at least a week, the bleeding of the gum will pass with you forever.

Foot feet! Horror! What to do? And the outlet is very simple. All recipes that we give are checked first of all on yourself and have a 100% guarantee of efficiency. So, get rid of sweating legs.

In history from the life of the patient much more useful than in all encyclopedias of the world. People need your experience - "Son of difficult mistakes." I ask everyone, send recipes, do not regret the council, they are for the patient - a ray of light!

About the medicinal property of pumpkin ingrown nail me 73 years old. Boyts appear as they did not even know what they exist. For example, on the thumb suddenly began to grow nail. The pain did not let me go. Offered an operation. I read about ointment from pumpkin. Cleaning the flesh from seeds, put to the nail and polyethylene bandaged to juice [...]

The fungus on the feet of the fungus on the legs in the pelvis pour hot water (the more hot, the better) and wipe the water soap in the water. Hold down the legs in it so that you should unwind them. Then make the soles and heels of pima, be sure to cut the nails. Wipe your feet dry, dry and lubricate them with a nutrient cream. Now take a pharmacy birch [...]

15 years of foot does not bother Natoptysh on his leg. For a long time I was disturbed by Natoptysh on the left foot. I cured him for 7 nights, got rid of pain and began to go rid. It is necessary to grate a piece of black radish on the grater, put it on a rag, tightly tie to the patient, wrap with cellophane and put on a sock. Compress It is advisable to do at night. To me […]

The young doctor prescribed the recipe for his grandmother gout, the spurs of the heel send you a recipe for the treatment of heel spurs and cones near the thumb. I gave me a young doctor about 15 years ago. He said: "I can't write down the hospital leaf on this occasion. But my grandmother was treated from these troubles so ... "I adopted the Council [...]

Let's start with the gout caused mainly by violation of metabolic processes. We will listen to what he speaks about Padagra Vinnitsa D.V.Naumov. We treat the gout of Naumov "Zozhe": a lot of questions about dissolving salts in the joints. You argue that the food salt, which we use inside, has nothing to do with insoluble salts of the type of urates, phosphates and oxalates. And what has [...]

According to the advice of Antonina Hlobrestina osteomyelitis in 12 years I have been sick with osteomyelitis and almost left without a leg. I was put in the hospital in serious condition and was operated on the same day. For a whole month, they were treated, and removed from the record only after 12 years. I was cured, after all, a simple folk agent, which I was suggested by Antonina Hlobobistin from Chelyabinsk-70 (now [...]

Fell, woke up - gypsum over the years they become very fragile, osteoporosis develops - especially the women suffer from this. What if you have a fracture? What in addition to plaster and bed mode can help yourself? With these questions, we turned to the doctor of biological sciences, Professor Dmitry Dmitrievich Sumarokov, a specialist in the restoration of bone fabrics. "Zoz": You are 25 years old [...]

Osteoporosis of the osteoporosis osteoporosis is called osteoporosis "silent thief". Quiet and without pain, calcium leaves bones. A person is sick of osteoporosis and knows nothing about it! And then unexpected bone fractures begin. In our hospital, a man was 74 years old with a fracture of the hip. He fell in an apartment in an even place - the bone could not stand the body and [...]

Renal artery

Renal artery (PA) - a paired terminal blood vessel, which supplies the kidney with blood. This artery brings blood to the front, lower, rear and upper kidney segments. 90% of blood is sent to the cortical substance, and only 10% - to the kidney cerebral substance.

Structure

The human body has the left and right pa, each of which is divided into the front and rear branches that are divided into segmental branches. If we talk about segmental branches, they are divided into interdel branches, disintegrating on the vascular grid, which consists of arc arteries.

Hanging artery disintegrates the capillaries that are taking off the renal tubules. These capillaries go to Vienna.

Stenosis

Stenosis is a partial occlusion artery or its main branches. This pathological state arises against the background of inflammation, as well as, as a result of the alternation of the artery, the tumor, atherosclerotic narrowing or vessel dysplasia.

Stenosis of the renal artery is characterized by a violation of the functioning of the kidney, renal failure and a sharp increase in blood pressure. In most cases, this disease proceeds asymptomatic. Long-term occlusion artery leads to azotemia, manifested fatigue, weakness and confusion of consciousness.

To reduce the pressure during stenosis of PA, medical officers prescribe antihypertensive drugs in combination with diuretic drugs. Also, the treatment of stenosis may include stenting and balloon angioplasty.

Resistant antihypertensive effect Modern medical schools achieve by denervation of renal arteries. Currently, catheter sympathetic denervation is the most effective bloodless method for the treatment of resistant hypertension. After this procedure, a stable decrease in blood pressure is observed during the year.

Aneurysm

Under the aneurysm of the renal artery is meant a bag-shaped expansion of the enlightenment of the artery, which is due to the absence in the wall of the muscular fiber vessel. Aneurysm PA in most cases is one-sided. It can be both extrarenal and intravenously. This is a pathological condition of arterial hypertension (an increase in blood pressure) and thromboembolism.

The aneurysm of the above artery is treated solely by the surgical method. This anomaly can be eliminated using the following operations:

aneurysmography (stitching the wall of the vessel with the aneurysm fabrics, which were left after excision of its main part);
excision of the aneurysm and replacement of the defect paid;
precision artery.

Anneuryography, as a rule, is carried out under large aneurysm and multiple vessel lesions.

Thrombosis

According to the reviews of medical professionals, renal artery thrombosis is the overlap of the renal blood flow to the thrombus, which broke away from abandoned vessels. PA thrombosis can provoke injury, atherosclerosis and inflammatory process. In 20-30% of cases, the overlap of the tirombonic blood flow bilateral.

PA thrombosis is characterized by a strong and sharp pain in the lower back, back or kidney, which gives in the side or stomach. Also, thrombosis can be accompanied by a significant increase in blood pressure, nausea, vomiting, hyperthermia and constipation.

Treatment of renal artery thrombosis complex: symptomatic therapy (anti-anemic, antipyretic, antihypertensive, painkillers and other drugs), anticoagulant treatment and operational intervention.

When using materials from the site, the active reference is obligatory.

The information provided on our website should not be used for self-diagnosis and treatment and cannot serve as a replacement for advice from a doctor. We warn about the presence of contraindications. Consultation of a specialist is necessary.

Vessels of kidneys

The main renal arteries depart from the aorta by 10-20 mm below the mesenteric artery, have a diameter of about 3-5 mm. The right artery is somewhat longer than renal veins and goes behind the lower hollow vein. A feature that distinguishes the artery from the extended ureter is periodic pulsation that coincides with the heart ripple. Right main renal artery is visualized in 95% of cases, left - 80%. Often, the left renal artery is visible fragmentary. The condition for visualization of the renal arteries in the region of their mouth is the lack of gas in the intestine. In the gate of the kidney, the main renal arterys are divided into segmental, located in the renal sine, the diameter of which on average is 2.1-2.3 mm. From segmental arteries, interdollastic arterys are departed,

Fig. 13.13. Kidney vessel diagram.

1 - uterine; 2 - Main renal artery; 3 - Main renal vein; 4 - segmental vessels; 5 - interdolt vessels; 6 - arcuate vessels.

Fig. 13.14. Ultrasound kidneys. Cross scanning from the front abdominal wall.

1 - liver; 2 - the front of the kidney surface; 3 - rear kidney surface; 4 - renal sinus; 5 - kidney gate; 6 - renal vein.

a meter of about 1.5 mm, heading into space between pyramids. These vessels are visualized as anechogenic linear structures, divergent from the kidney gate of the kidney-Arno, evenly distributed in the central echocomplex, each next generation of the previous one. In corticedullary zones there are arcuate arterys surrounding the base of the pyramids. The diameter of these arteries is 1.3-1.5 mm, and their hyper-human-gene walls clearly degrade the pyramids from the cortical coil layer (Fig. 13.13).

Renal veins have a somewhat larger diameter and, unlike arteries, not pulsate. Right main renal vein shorter artery, left - longer. The main renal vein is the Kepenta and below the artery. The right main renal vein is visible in 100% of cases, the left is more often determined from the place of intersection of it with the upper mesenteric artery to the place of sign into the lower hollow vein (Fig. 13.14). The visualization of the main kidney mainstream vessels is improved in the study through the stomach filled with liquid.

Renal artery diseases

Human buds perform their functions constantly and without a break. Their functions for the body are priceless. The main function is the purification of blood from toxic substances, is performed around the clock. The building of the renal system is complex, each individual organ performs its functions. Renal artery delivers blood to the kidneys. This pair blood vessel supplies a brainstant and a cortical substance.

Features and functions

Renal arteries are two. Both normally work equally and each supplies the right and left, respectively, there are left renal artery and right. They originate from the abdominal aorta. Their length is small. Both are divided into a number of smaller. All segmental branches are divided into interdet branches, which consist of arc arteries. In turn, they are distributed to the capillaries that go into renal arteries and veins.

Additional renal artery is a very common disease, in this case, blood flow comes from the additional artery. Additional in diameter less basic.

If there is a gradual narrowing or complete blockage of the lumen, then the functional operation of the renal system is deteriorating. Such pathologies can lead to renal failure or an increase in blood pressure. All renal arteries should be controlled to eliminate more serious pathologies.

The feature 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. With the increase in pressure, the muscular system is declining, while the blood enters significantly smaller volumes, which leads to a decrease in pressure. With a strong pressure decrease, the vessels are expanding 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 derived, the entire blood flow passes through the system in just 5 minutes. The blood circulation and the state of the renal arteries is very important to maintain in a healthy form, as they are extremely important for humans. If the renal artery is not fully functional, then the work of the kidneys will deteriorate, and therefore the overall condition of the body will be at risk.

Burning renal artery

The narrowing of the renal arteries can occur immediately with two or one. As a rule, the course of the disease is not rapid. The appearance of the blockage of the main veins, or any of their branches is very dangerous. This is a blood clot. Blood clot is moving along blood flow from any place in the body and stops in the renal artery, which leads to the complete closure of the lumen. Most often, blood clot is spoiled from the generated larger in the heart or in the aorta.

Damage to the walls directly can lead to the formation of a blood clots, which will subsequently affect the blockage. Damage can occur due to surgical intervention or after the antiography procedure or angioplasty. Under the influence of atherosclerosis, the vessels gradually collapse and the formation of clots occurs. Also destroy the arteries of a slow-dimensional expansion, which is called aneurysm.

Damage to the renal artery leads to blockage, however, in addition to blockage, the walls can also occur, therefore pathologies that can lead to the appearance of bunches must be eliminated immediately after detection. If the blood clot formation does not occur, some pathologies can lead to a significant narrowing that reduce the kidney nutrition. The disease at which the narrowing of the walls occurs, but the clot is not formed, called stenosis is called.

Stenosis of the renal artery

Stenosis of the renal artery Dangerous pathology. Stenosis is essentially narrowing the diameter of the vessels. In normal functioning, blood filtering leads to the formation of primary urine. When the walls are narrowing the blood volume decreases, the stronger the narrowing occurs, the less blood is the kidneys. The lack of blood leads to an increase in blood pressure, and the organ cleans the blood is much worse.

Stenosis of the renal arteries completely violates the work of the body. With a critical reduction in blood volume, as well as with a degraded power for a long time, the kidneys cease to function normally and the urine is not formed and not allocated. Stenosis is formed against the background of some diseases. Atherosclerosis, diabetes, aneurycism, some inflammatory processes, as well as neoplasms in renal arteries can provoke stenosis.

In order not to provoke the appearance of stenosis, this disease is extremely negatively affecting the state of the kidneys, as well as the overall human health, the risk of a very serious disease arises. If it does not apply therapeutic measures on time, the stenosis can lead to a violation of the hormonal background, a decrease in the level of protein, swelling and a decrease in the fluid released, reducing the amount of plasma.

Renal artery of the elderly

The walls of the arteries in the whole body with age characteristic thickening. Renal artery thickened slower than others. In the elderly, the thickness of the renal arteries is finally formed. It happens from the moment of birth. If the right renal vein is significantly thickened, then such a process is observed in the left and vice versa.

In newborns, the inner shell of hyperplastic thickening is splitted into two membranes. With the cultivation of the body, the elastic plate is divided into membranes repeatedly. There is an increase in the number of membranes at the beginning of the arteries, as well as in the place of the first separation into two separate branches, then it applies to the entire perimeter of the split arteries.

In an older age, changes lead to the appearance of an elastic layer with a connecting tissue and elastic fibers.

Age changes do not always lead to the development of pathological processes in the human body. Thickening occurs from any person and leads to the formation of fairly thick walls, which can resist damage. The simple structure of blood supply in newborns is perfectly coping with low loads and small blood volumes, but with the growth of the body, all processes become much more complicated, respectively, the thickening of the walls laid out by nature is appropriate.

Diagnostics of changes

When examining, the doctor may be based on the history collection to assign laboratory or instrumental diagnostic methods. The main symptoms of changes in the renal artery state:

Elevated blood pressure.
When analyzing the blood, an increase in erythrocytes is detected.
Reducing urine volume and urination frequency.

These symptoms are characteristic of other pathologies, therefore, when diagnosis, it is impossible to be based only on these symptoms. To study the state of the vessels, use a special Doppler device, which establishes how quickly the blood is moving along the blood supply system. Stenosis of the walls is successfully determined by this method, however, a slow blood flow device may not distinguish.

The introduction of an iodide contrast agent is characteristic of radiography, or x-ray, which also successfully determine the state of the renal artery and possible violations. The introduction of Galia during the MRI is the most highly precious research method, which will fully explore the condition of the entire system, as well as each individual vessel. With this method, it is possible to define diseases even in the early period of occurrence.

Stenosis of the renal arteries (PA): Causes, Signs, Diagnostics, How to Treat, Operation

Stenosis of the renal artery (SPA) is a serious illness, accompanied by a narrowing of the lumen of the vessel feeding the kidney. Pathology lies with not only nephrologists, but also cardiologists, since severe hypertension is usually becoming the main manifestation, difficult to correction.

Patients with stenosis of the renal artery are predominantly older people (after 50 years), but also young stenosis can also be diagnosed. Among the elderly with atherosclerosis of the vessels of men is twice as much more than women, and in congenital vascular pathology, female faces prevail, whose illness appears to post.

Every tenth, which suffers with increased arterial pressure, stenosis of trunk renal vessels has the main cause of this state. Today, more than 20 different changes are already known, leading to a narrowing of the renal arteries (PA), the increase in pressure and secondary sclerotic processes in the police parenchym.

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

Causes of PA stenosis

The most frequent causes of the narrowing of the renal artery are atherosclerosis and the fibromed dysplasia of the artery wall. Atherosclerosis accounts for up to 70% of cases of the disease, the fibromuscular dysplasia is about one third of the cases.

Atherosclerosis of the renal arteries with a narrowing of their lumen is usually found in the elderly men, often with the existing ischemic 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 amazed atherosclerosis, is much less likely to be affected by the average separation department and the branching zone in the organ parenchym.

Fibromuscular dysplasia is a congenital pathology at which the wall of the artery is thickened, which leads to a decrease in its lumen. This defeat is usually localized in the middle part of PA, is 5 times more often diagnosed in women and can be bilateral.

atherosclerosis (right) and fibromuscular dysplasia (left) - the main reasons for PA stenosis

About 5% spa is caused by other reasons, including inflammatory processes of vascular walls, aneurysmatic expansion, thrombosis and embolism of the kidney arteries, the compression of the tumor located outside, the disease of the kidney. Children encounters a intrauterine violation of the development of a vascular system with stenosis of PA, which manifests Hypertension in childhood.

It is possible both one-sided and double-sided stenosis of the renal arteries. The lesion of both vessels is observed with congenital dysplasia, atherosclerosis, diabetes and proceeds more malignant, because at once two kidneys are in a state of ischemia.

If blood flow is violated on the renal vessels, the system is activated that regulates blood pressure levels. Renin hormone and angiotensin-converting enzyme contribute to the formation of a substance that causes the spasm of small arterioles and an increase in peripheral vascular resistance. The result becomes hypertension. At the same time, adrenal glands produce excess aldosterone, under the influence of which the liquid and sodium are delayed, which also contributes to an increase in pressure.

Under the defeat, even one of the arteries, right or left, the above described mechanisms of hypertension are launched. Over time, the healthy kidney is "rebuilt" to a new level of pressure, which continues to maintain even if the patient is removed at all or restore the blood flow in it by angioplasty.

In addition to activating the pressure maintenance system, the disease accompany ischemic changes in the kidney itself. Against the background of the lack of arterial blood, the dystrophy of the tubules occurs, the connecting tissue in the stroma and glomers of the organ grows, which over time, inevitably leads to atrophy and nephrosclerosis. The kidney is compacted, decreases and unable to perform functions assigned to it.

Manifestations of spa

For a long time the spa may exist asymptomatic or in the form of benign hypertension. Bright clinical signs of the disease appear when the narrowing of the vessel reaches 70%. Among the symptoms are the most characters, secondary renal arterial hypertension and signs of violation of the parenchyma (decrease in urine filtration, intoxication of exchange products).

The persistent increase in pressure, usually without hypertensive crises, in young patients pursue a physician for the idea of \u200b\u200bpossible fibromuscular dysplasia, and if the patient crossed the 50-year-old frontier - the atherosclerotic lesion of the renal vessels.

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 state is extremely poorly treatable with standard hypotensive drugs and creates a large risk of cardiovascular disasters, including stroke and myocardial infarction.

Among the complaints of patients with renal hypertension are marked:

Strong headaches, noise in the ears, flickering "flies" before your eyes;
Reduction of memory and mental performance;
Weakness;
Dizziness;
Insomnia or drowsiness during the day;
Irritability, emotional instability.

A constant high load on the heart creates conditions for its hypertrophy, patients complain about pain in the chest, heartbeat, a sense of interruptions in the work of the body, shortness of breath appears, in severe cases, the pulmonary edema develops, requiring emergency care.

In addition to hypertension, heaviness and pain in the area of \u200b\u200bthe lower back, the appearance of blood in the urine, weakness. In the case of an excess of aldosterone isolate, the patients have a lot of drinks, highlights a large number of not concentrated urine not only during the day, but at night, convulsions are possible.

With the initial stage of the disease, the work of the kidney is preserved, but hypertension appears, which, however, is amenable to treating medicines. Subcompensation is characterized by a gradual decline in kidney work, and in the decompensation stage, signs of renal failure are clearly traced. Hypertension in the terminal stage becomes malignant, the pressure reaches maximum numbers and not "comes off" by drugs.

SPA is dangerous not only by its manifestations, but also complications in the form of hemorrhages in the brain, myocardial infarction, edema of the lungs against the background of hypertension. Most patients are affected by the retina, its detachment and blindness is possible.

Chronic renal failure, as the final stage of pathology, is accompanied by intoxicating exchange products, weakness, nausea, headache, small amount of urine, which kidneys can be filtered independently, the increase in edema. Patients are subject to pneumonia, pericarditis, inflammation of the peritoneum, affecting the mucous upper respiratory tract and the digestive tract.

How to reveal the stenosis of the renal arteries?

The patient examination in suspected stenosis of the left or right renal artery begins with a detailed clarification of the complaints, the time of their appearance, an answer to the conservative treatment of hypertension, if it was already appointed. Next, the doctor will lead hearing the heart and large vessels, prescribe blood and urine tests and additional instrumental examinations.

stenosis of both renal arteries on an angiographic picture

In the primary inspection, you can already identify the expansion of the heart due to hypertrophy of the left departments, the strengthening of the second tone above the aorta. In the upper stomach departments, noise listens to the narrowing of the renal arteries.

The main biochemical indicators of the spa will be the level of creatinine and urea, which increase due to the insufficient filtering ability of the kidneys. In the urine you can detect red blood cells, leukocytes, protein cylinders.

An ultrasound is used from additional diagnostic methods (the kidneys is reduced in size), and the Dopplerometry allows you to fix the narrowing of the artery and changing the speed of blood in it. Information on sizes, location, functional abilities can be obtained by radioisotope research.

The most informative diagnostic method is recognized as arteriography when with the help of contrasting radiography determine the localization, the degree of stenosis pa and the impaired hemodynamics. It is also possible to conduct CT and MRI.

Treatment of renal artery stenosis

Before proceeding with treatment, the doctor will recommend the patient to abandon the bad habits, begin to adhere to a diet with reduced salt consumption, limit liquid, fats and easily accessible carbohydrates. In atherosclerosis with obesity, weight should be reduced, since obesity can create additional difficulties in planning surgical intervention.

Conservative therapy in the stenosis of the renal arteries is auxiliary, it does not allow to eliminate the main cause of the disease. At the same time, patients need blood pressure and urinary correction. Long-term therapy is shown to people of elderly and persons with a common atherosclerotic lesion of vessels, including coronary.

Since the main manifestation of the stenosis of the kidney artery becomes symptomatic hypertension, the treatment is directed, first of all, to reduce blood pressure. For this purpose, diuretics and antihypertensive means are prescribed. It should be borne in mind that with a strong narrowing of the lumen of the renal artery, the reduction in pressure to normal numbers contributes to the aggravation of ischemia, because the blood to the police parenchym in this case will come even less. Ischemia will cause the progression of sclerotic and dystrophic processes in the tubules and glomers.

The drugs for the choice of hypertension on the background of PA stained inhibitors are becoming inhibitors of ACE (kapropryl), however, with an atherosclerotic narrowing of the vessels, they are contraindicated, including those with stagnant heart failure and diabetes, so replace:

Cardioslelective beta blockers (Atenolol, Egilov, Bisoprolol);
Blockers of slow channels calcium (verapamil, nifedipine, diltiazem);
Alpha-adrenoblockers (prazozin);
Loop diuretics (furosemide);
Agonists of imidazoline receptors (Moxonidine).

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

Patients with atherosclerotic stenosis need the appointment of statins to correct the violations of bodybuilding, with diabetes show hypolypidemic tools or insulin. In order to prevent thrombotic complications, aspirin, clopidogrel apply. In all cases, the dosage of drugs is selected taking into account the filtering ability of the kidneys.

In severe renal failure against the background of atherosclerotic nephrocarosis, hemodialysis or peritoneal dialysis in an outpatient basis is prescribed patients.

Conservative treatment often does not give the desired effect, because the stenosis is impossible through drugs, therefore, only a surgical operation can be the main and most effective event, which indications of which are considered:

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 insufficiency of the organ with the defeat of one of the arteries;
Complications (pulmonary edema, unstable angina).

Types of interventions used in Spa:

Stenting and balloon angioplasty;
Shunting;
Resection and prosthetics of the renal artery section;
Removal of the kidney;

angioplasty and stenting

Stenting lies in the installation in the lumen of the renal artery of a special tube from synthetic materials, which is strengthened in the scene of the stenosis and allows you to establish blood flow. With balloon angioplasty through the femoral artery, a special cylinder is introduced along the catheter, which is inflated in the stenosis zone and thereby expands it.

Video: angioplasty and stenting - minimally invasive method of treatment SPA

In atherosclerosis of the renal vessels, the best effect will give shunt when the renal artery is laid to the aorta, excluding the place of the stenosis of blood flow. It is possible to remove the vessel portion and the subsequent prosthetics with the patient's own vessels or synthetic materials.

A) renal artery prosthetics and b) two-sided shunting with a synthetic prosthesis

With the impossibility of performing reconstructive interventions and the development of atrophy and sclerosis of the kidney, the removal of the organ (nephrectomy) is shown, which is carried out in 15-20% of pathology. If the stenosis is caused by congenital reasons, then the question of the need for the kidney transplantation is considered, while during atherosclerosis of the vessels is not carried out.

In the postoperative period, complications are possible in the form of bleeding and thrombosis in the field of anastomoses or stents. Restoration of the permissible level of blood pressure may require up to six months, during which conservative hypotensive 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 possibility of surgical correction of pathology. In atherosclerosis, a little more than half of the patients are returned to normal pressure indicators, and in the case of vascular dysplasia, surgical treatment allows it to restore it from 80% of patients.

What diseases are affected by the renal artery

Renal artery supplies the kidney with blood, providing it with the ability to perform its work. It has features caused by its functions. If there are problems with this vessel, the normal work of the kidney is inevitably violated.

How the renal artery is arranged

Renal arteries in our organism are two, and each of them is divided into two large and several small branches. Ultimately the vascular grid is created.

From her, smaller arterial vessels depart to the renal capsule and carry blood to the kidney pyramids. Next, bringing the vessels are divided into clubs of capillaries, which are covered by the glomes and tubules of the body.

The endowing arteries also disintegrate on the capillaries that the tubules are tired and go to veins.

The right artery is longer left, it goes from the aorta behind the lower hollow vein.

Pathology

Pathological changes in the kidney arteries can have a congenital nature or acquired for various reasons. Congenital vascular anomalies are usually associated with the deviations in the development of the kidneys.

Defects are mainly accompanied by tissue dysplasia, dystopia or doubling renal structures. All these pathologies are developing during the intrauterine period and are due to the unfavorable impact on the woman during pregnancy or its illnesses.

The kidney of the child is formed by the entire intrauterine period, so they are subject to any negative impact.

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

Diagnostic research

Auscultation.
CT scan.
Dopplerography.
Arteriography.

The easiest and most affordable method of diagnosis is auscultation, that is, listening to the renal arteries.

It is carried out using a conventional phonedoscope, which is installed above the vessel run. If the blood current passes unhindered, no noises and tones are listened.

With a narrowing or presence of obstacles to the blood flow path, the doctor will hear systolic noise.

The most voluminous and informative research can be called Dopplerography. This duplex scanning, which makes it possible to assess the condition of not only vessel tissues, but blood flow in it.

According to the results of 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 disorders and their severity.

The whole procedure takes no more than half an hour.

What is Stenosis

Stenosis is a partial occlusion, that is, the narrowing of the glorification of the artery itself or some of its main branches. Causes can be:

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

Stenosis may be caused by a tumor. When the neoplasm reaches certain sizes, it presses on the vessel, and its lumen decreases. Occlusion can occur due to the thickening of the inner vascular shells. Such thickening cause inflammatory or atherosclerotic processes.

One of the reasons for the resistant is difficult to disappear hypertension, which arises as the consequence of the stenosis of the kidney artery, is a fibromuscular dysplasia. It is a damage to the tissues of the vascular wall, which lead to the formation of a vessel reliever and a violation of normal blood flow.

Stenosis often proceeds asymptomatic, but a long narrowing of the lumen of the vessel disrupts the kidney trophy and inevitably affects her work.

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

This disease is manifested by such symptoms as excessive fatigue, weakness, the confusion of consciousness is possible.

When treating, first of all, attention is paid to the decrease in blood pressure indicators. This uses drug therapy and surgical methods. Effective stenting and balloon angioplasty.

A steady effect in terms of normalization of blood pressure gives catheter denervation.

What is this procedure? With the help of a catheter through a large femoral vessel, a special device is introduced, which performs radio frequency cavity of certain kidney arteries.

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

Aneurysm of vessels of kidneys

Aneurysm is the protrusion of the tissue of the vessel wall due to its stretching, reduce tone or damage. A small aneurysm may not give symptoms, but the narrowing of the lumen disrupts blood flow, which leads to hypertension. In addition, thromboembolism is possible, since at the place of the obstacle with increased switches, the erythrocytes occurs.

Treatment of this pathology is only surgical. Today, various techniques are applied for this.

What is thrombosis and what it is dangerous

Thrombosis occurs during the overlap of a large renal vessel by Trombus. Such a state can be the consequence of atherosclerosis, and provoking the tomb of the thrombus may injury or inflammatory process.

In thrombosis, an acute kidney pain occurs, which can spread on the stomach, give up.

Breasting the kidney is accompanied by an increase in blood pressure, nausea and vomiting is possible.

Treatment depends on the degree of occlusion of the artery. A set of measures is usually applied, which include symptomatic and anticoagulant treatment. In cases where immediate assistance is required, a surgical operation is shown.

Since renal artery is a major vessel that plays a strategic role in ensuring kidney functions, any problems arising in it are dangerous. It is not necessary to postpone the diagnosis, to see the doctor follows at the first symptoms of such a dysfoliage in the field of urinary tract.

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

Renal artery: structure, functions, possible pathologies

Human buds perform their functions constantly and without a break. Their functions for the body are priceless. Function - blood purification from toxic substances, is performed around the clock. The building of the renal system is complex, each individual organ performs its functions. Renal artery delivers blood to the kidneys. This pair blood vessel supplies a brainstant and a cortical substance.

Features and functions

Both are divided into a number of smaller. All segmental branches are divided into interdet branches, which consist of arc arteries.

In turn, they are distributed to the capillaries that go into renal arteries and veins.

Additional renal artery is a very common disease, in this case, blood flow comes from the additional artery. Additional in diameter less basic.

If there is a gradual narrowing or complete blockage of the lumen, then the functional operation of the renal system is deteriorating. Such pathologies can lead to renal failure or an increase in blood pressure. All renal arteries should be controlled to eliminate more serious pathologies.

The feature 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.

With the increase in pressure, the muscular system is declining, while the blood enters significantly smaller volumes, which leads to a decrease in pressure. With a strong pressure decrease, the vessels are expanding and the pressure rises.

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

Burning renal artery

Blood clot is moving along blood flow from any place in the body and stops in the renal artery, which leads to the complete closure of the lumen. Most often, blood clot is spoiled from the generated larger in the heart or in the aorta.

Damage to the walls directly can lead to the formation of a blood clots, which will subsequently affect the blockage.

Damage can occur due to surgical intervention or after the antiography procedure or angioplasty. Under the influence of atherosclerosis, the vessels gradually collapse and the formation of clots occurs.

Also destroy the arteries of a slow-dimensional expansion, which is called aneurysm.

If the blood clot formation does not occur, some pathologies can lead to a significant narrowing that reduce the kidney nutrition.

The disease at which the narrowing of the walls occurs, but the clot is not formed, called stenosis is called.

Stenosis of the renal artery

Stenosis of the renal arteries completely violates the work of the body.

With a critical reduction in blood volume, as well as with a degraded power for a long time, the kidneys cease to function normally and the urine is not formed and not allocated.

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

Renal artery of the elderly

In an older age, changes lead to the appearance of an elastic layer with a connecting tissue and elastic fibers.

Age changes do not always lead to the development of pathological processes in the human body. Thickening occurs from any person and leads to the formation of fairly thick walls, which can resist damage.

The simple structure of blood supply in newborns is perfectly coping with low loads and small blood volumes, but with the growth of the body, all processes become much more complicated, respectively, the thickening of the walls laid out by nature is appropriate.

Diagnostics of changes

When examining, the doctor may be based on the history collection to assign laboratory or instrumental diagnostic methods. The main symptoms of changes in the renal artery state:

Elevated blood pressure.
When analyzing the blood, an increase in erythrocytes is detected.
Reducing urine volume and urination frequency.

These symptoms are characteristic of other pathologies, therefore, when diagnosis, it is impossible to be based only on these symptoms.

To study the state of the vessels, use a special Doppler device, which establishes how quickly the blood is moving along the blood supply system.

Stenosis of the walls is successfully determined by this method, however, a slow blood flow device may not distinguish.

The introduction of an iodide contrast agent is characteristic of radiography, or x-ray, which also successfully determine the state of the renal artery and possible violations.

The introduction of Galia during the MRI is the most highly precious research method, which will fully explore the condition of the entire system, as well as each individual vessel.

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

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

Stenosis of the renal arteries (PA): Causes, Signs, Diagnostics, How to Treat, Operation

Patients with stenosis of the renal artery are predominantly older people (after 50 years), but also young stenosis can also be diagnosed. Among the elderly with atherosclerosis of the vessels of men is twice as much, rather than women, and in congenital vascular pathology, female faces prevail, in which the disease is manifested after 30-40 years.

The prevalence of pathology requires not only modern and accurate diagnostic methods, but also timely and effective treatment. It is recognized that the best results can be achieved when conducting surgical treatment of stenosisWhile conservative therapy plays an auxiliary role.

Causes of PA stenosis

Atherosclerosis Renal arteries with a narrowing of their lumen is usually found in older men, often with existing ischemic 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 amazed atherosclerosis, is much less likely to be affected by the average separation department and the branching zone in the organ parenchym.

Fibromuscular dysplasia It is a congenital pathology at which the artery wall thickens, which leads to a decrease in its lumen. This defeat is usually localized in the middle part of PA, is 5 times more often diagnosed in women and can be bilateral.

atherosclerosis (right) and fibromuscular dysplasia (left) - the main reasons for PA stenosis

About 5% spa is caused by other reasons, including inflammatory processes of vascular walls, aneurysmatic expansion, thrombosis and embolism of the kidney arteries, the compression of the tumor located outside, the disease of the kidney. Children encounters a intrauterine violation of the development of a vascular system with stenosis of PA, which manifests Hypertension in childhood.

It is possible both one-sided and double-sided stenosis of the renal arteries. The lesion of both vessels is observed with congenital dysplasia, atherosclerosis, diabetes and proceeds more malignant, because at once two kidneys are in a state of ischemia.

If blood flow is violated on the renal vessels, the system is activated that regulates blood pressure levels.

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

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

Manifestations of spa

For a long time the spa may exist asymptomatic or in the form of benign hypertension. Bright clinical signs of the disease appear when the narrowing of the vessel reaches 70%. Among the symptoms are the most characters, secondary renal arterial hypertension and signs of violation of the parenchyma (decrease in urine filtration, intoxication of exchange products).

Among the complaints of patients with renal hypertension are marked:

Strong headaches, noise in the ears, flickering "flies" before your eyes;
Reduction of memory and mental performance;
Weakness;
Dizziness;
Insomnia or drowsiness during the day;
Irritability, emotional instability.

With the initial stage of the disease, the work of the kidneys is preserved, but Hypertension appears, which, however, is amenable to medication.

Subcompensation is characterized by a gradual decline in kidney work, and in the decompensation stage, signs of renal failure are clearly traced.

Hypertension in the terminal stage becomes malignant, the pressure reaches maximum numbers and not "comes off" by drugs.

How to reveal the stenosis of the renal arteries?

stenosis of both renal arteries on an angiographic picture

An ultrasound is used from additional diagnostic methods (the kidneys is reduced in size), and the Dopplerometry allows you to fix the narrowing of the artery and changing the speed of blood in it. Information on sizes, location, functional abilities can be obtained by radioisotope research.

Treatment of renal artery stenosis

Conservative therapy in the stenosis of the renal arteries is auxiliary nature,it does not allow to eliminate the main cause of the disease. At the same time, patients need blood pressure and urinary correction. Long-term therapy is shown to people of elderly and persons with a common atherosclerotic lesion of vessels, including coronary.

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

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

In severe renal failure against the background of atherosclerotic nephrocarosis, hemodialysis or peritoneal dialysis in an outpatient basis is prescribed patients.

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 insufficiency of the organ with the defeat of one of the arteries;
Complications (pulmonary edema, unstable angina).

Types of interventions used in Spa:

Stenting and balloon angioplasty;
Shunting;
Resection and prosthetics of the renal artery section;
Removal of the kidney;
angioplasty and stenting
Transplantation.

: angioplasty and stenting - minimally invasive method of treatment of spa

In atherosclerosis of the renal vessels, the best effect will give shunting, When the renal artery is laid to the aorta, excluding the place of the stenosis from the blood flow. It is possible to remove the vessel portion and the subsequent prosthetics with the patient's own vessels or synthetic materials.

A) renal artery prosthetics and b) two-sided shunting with a synthetic prosthesis

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

Additional artery of the right kidney

Approximately 35% of the total population of the globe suffers from the diseases of the urinary system. Approximately 25-30% associated with kidney anomalies. These include: the aneurysms of the kidney arteries, multiple or double renal arteries, solitary artery, the addition of the kidney, fibromascular stenosis, etc.

Additional kidney artery - what is it?

Additional renal artery is the most common void damage for kidney vessels. This disease occurs in about 80% of cases, in humans suffering from kidney disease. The added artery is called the artery, which, along with the main renal artery, the blood suite of the kidney.

With this anomaly from the kidney, two artery departs: the main and additive. Additional rushes to the upper or lower kidney segment. The diameter of the additional artery is less than the main one.

Anomaly occurs during the period of embryonic development, the reason for such deviations is unknown. It is assumed that for non-observed reasons, there is a failure of normal development, as a result of which, the renal artery may have a doubling.

Views

There are several species of pathologies of renal vessels - artery depending on their quantity:

Double and multiple. Double extension artery is rare. The second artery is usually reduced, and is located in a loyalty in the form of branches on the left or right. Multiple arteries are found in the norm and in pathology. We depart in the form of small blood vessels. Types of added renal artery

Clinical picture

The disease, as a rule, proceeds asymptomatic. It is manifested only with the intersection of the urinary tract of the extension artery.

Because of this crossing, the outflow of urine from the kidneys is hampered, with the result that such clinical manifestations arise:

For the prevention of diseases and renal treatment, our readers advise the monastery collection of Father George. It consists of 16 useful medicinal herbs that have extremely high efficiency in the purification of kidneys, in the treatment of renal diseases, urinary tract diseases, as well as when cleaning the body as a whole.

»Hydronephrosis - resistant and rapid expansion of the renal pelvis, resulting from a violation of urine outflow. Arterial hypertension - increased blood pressure (AD).

The blood pressure jump occurs due to the patient content of the liquid in the body, the vessels are narrowed, the blood current is hampered, the pressure increases as a result. Infarction kidney.

With long-term hydronephrosis, gradual atrophy of the renal parenchyma arises, which in the future leads to a heart attack of the whole kidney. The formation of blood clots and bleeding in places crossing the addition artery with urinary tracts.

The kidney increases in size. Blood can be found in the urine, hiking to the toilet become painful. Patients complain about the nunning pain in the lower back and high blood pressure.

When palpation develops pain syndrome in the form of attacks of kidney colic, pain can also be irradiated into the ribs area, both during physical exertion and at rest.

Diagnostics

Most often double and multiple renal arteries are diagnosed. In this case, the rejection of the blood supply to the kidney is performed by two and more equal in caliber channels. The disease is difficult to determine, since such renal arteries are observed in a healthy kidney. They do not always organize pathology, but often combined with other types of pathologies.

The definition of the presence of renal pathologies is carried out using a x-ray study.

To determine special cases of abnormal renal arteries, use:

Excretory urography; Lower cavulus; Renal phlebography; AORTOGRAPHY.

When a patient detects a double or multiple renal artery, the resulting pyelograms make it possible to detect the defects of the ureter filling, notice the narrowing and bending in the location of the vessel, pyeloktasia.

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

Alignment techniques are widespread as common methods: ultrasound renal doppecography, MSCT and

MRI kidney

Treatment

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

Recreation of the extension artery. Removal can be complete and partial. Partial - removal of the extension artery and the damaged area is almost. Complete removal is the removal of both the addition artery and the whole kidney.

Resection of urinary tract. This operation is carried out when the residency of the additional artery is impossible. The narrowed plot of urinary tract is removed and again stitched.

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

Deviations in the field of urology are often found. One of these violations is an anomalies of renal arteries. Extreme renal artery is a frequent type of pathology, may occur against the background of other renal pathologies, but sometimes independent. The cause of this pathology is distinguished by embryonic vascularization of the structure of the body.

Additional artery in the kidney is a smaller blood vessel than the main aorta, which can be from the abdominal, renal, curl, diaphragmal or iliac artery on the movement to the upper or lower edges of the kidney, or be a process from the main line.

As a result, the supply of kidney blood comes from several places at the same time.

At the upper direction of the extension aort of the organ, there is no disorders in the system. More often such pathology opens with kidney blood vessel radiography. Arteries moving down - the main causes of the violation of the functionality of the organs and are a provoking factor in diseases such as uronifroz (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 urogenital system.

Symptoms of the presence of an extensive kidney arteries

For the presence of an additional renal artery may indicate such signs:

hypertension (blood pressure increase); increase, obstruction of urinary tract; pain sensations in lumbar departments; urolithiasis; renal jade.

Diagnostics

The "extra" arteries of the kidneys are detected by a comprehensive hardware examination.

To diagnose an additional renal vessel, a variety of ways are used. A frequent and effective method is an ultrasound study. For the diagnosis of this anomaly, the method of the Doppler scanner is used.

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

However, with a slow fluid flow, the device will not lock the movement.

For the study of renal vessels, methods use with the use of contrasting solutions. These include:

conventional X-ray studies; Computer radiography; magnetic resonance imaging (MRI); digital subtraction angiography.

Treatment of anomaly

After a full examination, the doctor assigns a specific treatment for each case, repulsiating from the data obtained. The main task of therapy is to restore a healthy urine outflow from the kidneys. This is achieved in resection of the kidneys or resection of sclerotically aligned urinary tract zones, with the help of ureterooretero or ureteropelostomy.

Do not forget, the diagnosis "Additional renal artery" carries danger to the body as a whole and its individual systems.

It is necessary to monitor changes in your body, contact the doctor in preventive purposes and, especially with such symptoms, as: pain in the head; sharp increase in blood pressure; pain in lumbar departments; changed color, volume and other visible urine properties; Etoh state in the morning. Their ignoring is dangerous to health.

Extreme renal artery

Lopatkin wrote: "To avoid confusion, each vessel from the aorta besides the main renal artery, it is advisable to call an additional, and the term" multiple arteries "use when it means all the supply of the kidney in such cases."

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

Such arterys "have less caliber compared to the main, go to the upper or lower segment of the kidneys, both from the abdominal aorta and from the main trunk of the renal, adrenal, cranky, diaphragmal or general iliac artery." There is no clear difference in the interpretation of these concepts. A in Ivanazyan and A.M.

War-Yasenetsky strictly delimited the concepts of "multiple trunk", "added" and "tasking" of the kidney arteries. "Multiple trunk arteries" originate from the aorta and fall into the renal recess. The source of "added arteries" is common and outdoor. Current, medium adrenal, lumbar arteries. But they all fall through the renal recess.

"Proprietary vessels" - penetrating the kidney outside its gate. Another interpretation of the anomalies of the number of renal arteries, we found in the "Campbell's Urology" manual (2002). In it S.B.

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

"Aberrant arteries" we called vessels separating from the renal artery and penetrating the kidney outside the renal sinus. Extreme renal artery can be separated from the aorta, renal, diaphragmal, adrenal, cereal, ileal vessels and are directed to the upper or lower kidney segment.

There are no differences in the side of the arrangement of additional arteries.

Double and multiple renal arteries

Double and multiple renal arteries are the form of an anomaly of the renal vessels in which the kidney receives blood supply from two or more equal to the caliber of the trunks.

Additional or multiple arteries in the overwhelming number of observations are found in normal kidney and do not lead to pathology, but quite often combined with other kidney anomalies (dubstical, double, dystopic, horseshoe kidney, polycystic, etc.).

Solitary renal artery

The solitary renal artery that feeds both kidneys is an extremely rare view of the anomalies of the renal vessels.

Distopia of the renal artery deposition

Anomalies of the location - anomaly of the renal vessels, the main criterion in determining the type of kidney dystopia:

lumbar - with a low existence of the renal artery from the aorta;. iliac - when disbeling from the general iliac artery; Pelvic - when disbeling from the internal ileal artery.

Aneurysm of renal artery

Aneurysm can be located both extrarenal and intravenously. Clinically manifested by arterial hypertension diagnosed for the first time in youthful age.

It can lead to renal arteries thromboembolism with the development of kidney infarction.

Fibromuscular stenosis

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

It represents a few alternative narrowings in the form of "thread beads" in the medium or distal third of the renal vessel arising from the overhaul of fibrous and muscle tissues in the renal artery wall. May be bilateral.

It is manifested in the form of a difficult to correct arterial hypertension of bloodless flow. Treatment operational. The type of operation depends on the prevalence and localization of the vice.

Congenital arteriovenous fistulas

Congenital arteriovenous fistulas are less common (0.02%). They are more often localized in arcuate and lobby vessels and can be multiple. The symptoms of venous hypertension (hematuria, proteinuria, varicocele) are manifested.

Congenital change of renal veins

Congenital change in renal veins can be divided into anomalies of quantity, shape and location, structure.

Anomalies of the right renal vein are mainly associated with doubling or triple. Left renal vein, besides increasing the quantity, may have an anomaly of the form and position.

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

The left renal vein can pass in front, behind and around the aorta, do not fall into the lower hollow vein (extracasive loss and the innate absence of the order department).

Anomalies of the structure include renal vein stenosis. It can be permanent or orthostatic.

The clinical significance of these vices is that the development of venerable hypertension is possible, and as a result, hematuria, varicocele, a disturbance of the menstrual cycle. The influence of venous anomalies on the risk of tumor development of the kidneys is proven.

Earlier, the "gold standard" diagnosis of the anomalies of the renal vessels was angiography, but recently it became possible to diagnose these defects with less invasive methods - digital subtractive angiography, color ehodstallography, MSCT, MRI.

Stenosis of the renal artery (spa) is serious disease, accompanied by the narrowing of the lumen of the vessel feeding the kidney. Pathology lies in the conduct of not only nephrologists, but also cardiologists, since a strong manifestation is usually becoming strong, difficult to correction.

Patients with stenosis of the renal artery are predominantly older people (after 50 years), but also young stenosis can also be diagnosed. Among the elderly with atherosclerosis of the vessels of men is twice as much, rather than women, and in congenital vascular pathology, female faces prevail, in which the disease is manifested after 30-40 years.

Every tenth, suffering in elevated, stenosis of trunk renal vessels as the main cause of this state. Today, more than 20 different changes are already known, leading to a narrowing of the renal arteries (PA), the increase in pressure and secondary sclerotic processes in the police parenchym.

Causes of PA stenosis

The most frequent causes of the narrowing of the renal artery are atherosclerosis and the fibromed dysplasia of the artery wall. A share accounts for up to 70% of cases of the disease, the fibromuscular dysplasia is about one third of the cases.

Atherosclerosis Renal arteries with a narrowing of their lumen is usually found in older men, often with existing ischemic 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 amazed atherosclerosis, is much less likely to be affected by the average separation department and the branching zone in the organ parenchym.

atherosclerosis (right) and fibromuscular dysplasia (left) - the main reasons for PA stenosis

About 5% spa is caused by other reasons, including inflammatory processes of vascular walls, aneurysmatic expansion, and the arteries of kidneys, a compression of the tumor located outside, the omission of the kidney. Children encounters a intrauterine violation of the development of a vascular system with stenosis of PA, which manifests Hypertension in childhood.

It is possible both one-sided and double-sided stenosis of the renal arteries. The defeat of both vessels is observed with congenital dysplasias, atherosclerosis, and more malignantly flows, because at once two kidneys are in a state of ischemia.

With a defeat, even one of the arteries, Right or left, the above described mechanisms of hypertension are launched. Over time, the healthy kidney is "rebuilt" to a new level of pressure, which continues to maintain even if the patient is removed at all or restore the blood flow in it by angioplasty.

Manifestations of spa

For a long time the spa may exist asymptomatic or in the form of benign hypertension. Bright clinical signs of the disease appear when the narrowing of the vessel reaches 70% . Among the symptoms are the most characters of renal arterial hypertension and signs of violation of the work of Parenhim (decrease in urine filtering, intoxication of exchange products).

Resistant increase in pressure, Usually without hypertensive crises, young patients have a physician on the idea of \u200b\u200bpossible fibromuscular dysplasia, and if the patient crossed the 50-year-old frontier - most likely an atherosclerotic lesion of the renal vessels.

Among the complaints of patients with renal hypertension are marked:

Strong headaches, noise in the ears, flickering "flies" before your eyes;
Reduction of memory and mental performance;
Weakness;
Dizziness;
Insomnia or drowsiness during the day;
Irritability, emotional instability.

A constant high load on the heart creates conditions for it, patients complain about pain in the chest, heartbeat, a sense of interruptions in the work of the body, shortness of breath appears, in severe cases, the pulmonary edema develops, requiring emergency care.

With the initial stage of the disease, the work of the kidneys is preserved, but Hypertension appears, which, however, is amenable to medication. Subcompensation is characterized by a gradual decline in kidney work, and in the decompensation stage, signs of renal failure are clearly traced. Hypertension in the terminal stage becomes malignant, The pressure reaches the maximum digits and not "comes off" by drugs.

SPA is dangerous not only by its manifestations, but also complications in the form of hemorrhages in the brain, myocardial infarction, edema of the lungs against the background of hypertension. Most patients are affected by the retina, its detachment and blindness is possible.

How to reveal the stenosis of the renal arteries?

stenosis of both renal arteries on an angiographic picture

The main biochemical indicators of the spa will be the level and that increase due to the insufficient filtering ability of the kidneys. In the urine you can detect red blood cells, leukocytes, protein cylinders.

Of the additional diagnostic methods apply Ultrasound (the kidneys are reduced in size), and dopplerometry Allows you to fix the contraction of the artery and changing the speed of blood in it. Information on sizes, location, functional abilities can be obtained by radioisotope research.

The most informative method of diagnosis is recognized when with the help of contrasting radiography determine the localization, the degree of stenosis pa and the impaired hemodynamics. Perhaps also conducting Kt. and MRI.

Treatment of renal artery stenosis

Before proceeding with treatment, the doctor will recommend the patient to abandon the bad habits, begin to adhere to a diet with reduced salt consumption, limit liquid, fats and easily accessible carbohydrates. In atherosclerosis with obesity, weight should be reduced, since obesity can create additional difficulties in planning surgical intervention.

Since the main manifestation of the stenosis of the kidney artery becomes symptomatic hypertension, the treatment is directed, first of all, to reduce blood pressure. For this purpose, diuretics are appointed and. It should be borne in mind that with a strong narrowing of the lumen of the renal artery, the reduction in pressure to normal numbers contributes to the aggravation of ischemia, because the blood to the police parenchym in this case will come even less. Ischemia will cause the progression of sclerotic and dystrophic processes in the tubules and glomers.

Preparations of selection with hypertension on the background of PA stenosis are becoming (kapropril), however, with an atherosclerotic narrowing of the vessels they contraindicated Including, persons with stagnation of heart failure and diabetes, so replace:

Cardioslelective (Atenolol, Egilov, Bisoprolol);
(Verapamil, Nifedipine, Diltiazem);
Alpha-adrenoblockers (prazozin);
Looped (furosemid);
Agonists of imidazoline receptors (Moxonidine).

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

Patients with atherosclerotic stenosis need an appointment to correct fat violations, hypolypidemic tools or insulin are shown in diabetes. In order to prevent thrombotic complications, aspirin, clopidogrel apply. In all cases, the dosage of drugs is selected taking into account the filtering ability of the kidneys.

In severe renal failure against the background of atherosclerotic nephrocarosis, hemodialysis or peritoneal dialysis in an outpatient basis is prescribed patients.

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 insufficiency of the organ with the defeat of one of the arteries;
Complications (pulmonary edema, unstable angina).

Types of interventions used in Spa:

Video: angioplasty and stenting - minimally invasive method of treatment SPA

A) renal artery prosthetics and b) two-sided shunting with a synthetic prosthesis

The prognosis of the disease is determined by the degree of stenosis, the nature of secondary changes in the kidneys, the effectiveness and possibility of surgical correction of pathology. In atherosclerosis, a little more than half of the patients are returned to normal pressure indicators, and in the case of vascular dysplasia, surgical treatment allows it to restore it from 80% of patients.

Anatomy of the vessels of the Big Circulation Circulation Circulation Circulation Circulation Courtyard Cure Part of Aorta Internal branches of the abdominal part of the aorta

Renal artery, a. Renalis (Fig. 776, 777, 778, 779; See Fig. 767) - Pair Large Artery. It starts from the side wall of the aorta at the level II level of the lumbar vertebra almost at right angles to the aorta, 1-2 cm below the extrusion of the upper mesenteric artery. Right renal artery is somewhat longer than the left, as the aorta lies on the left of the midline; Going to the kidney, it is located behind the lower hollow vein.

Fig. 777. The arteries and veins of the kidneys (a photograph of the corrosion preparation. Preparation M. Burys). 1 - renal artery; 2 - renal artery branches; 3 - branches of the renal vein; 4 - renal vein; 5 - bottom hollow vein; 6 - renal loching; 7 - ureter. Fig. 776. Renal artery, a. Renalis, left, and its branches. (Part of the kidney parenchyma is removed; injected vessels are cleaned.)

Without reaching the kidney gates, each renal artery gives a small lower adrenal artery, a. SUPRARENALIS INFERIOR, which, penetrating the adrenal panery, anastomoses with the branches of the middle and upper adrenal arteries.

Fig. 778. Kidney and adrenal vessels; Front view (radiograph).

In the field of the kidney gate, the renal artery is divided into the front and rear branches (see Fig. 776, 777).

Front branch, r. Anterior, enters the renal gate, passing ahead of the renal jelly, and branches, sending artery to four kidney segments: the artery of the upper segment, a. Segmenti Superioris, - to the top; Artery of the upper front segment, a. Segmenti Anterior Superioris, - to the upper front; The artery of the lower front segment, and. Segmenti Anterioris Inferioris, - to the bottom front and artery of the lower segment, a. Segmenti Inferioris, - To Lower. Rear branch, r. Posterior, renal artery goes behind the renal loin and, heading into the rear segment, gives the ureter branch, r. Uretericus, which can be separated from the renal artery itself, is divided into the rear and front twigs.

The first St. Petersburg State Medical University AK. I.P. Pavlova

Department of Clinical Anatomy and Operational Surgery. prof. MG Promses

Head Department Professor Akopov Andrey Leonidovich

"Surgical anatomy of the kidney arteries and the applied value of the options (topographic anatomy of the kidney arteries). Additional kidney arteries. Technique performing renal resection and nephroctomy. "

Performed:

student 4 courses, gr. 402.

Petukhova Galina Aleksandrovna

Checked:

Makeeva Tatyana Konstantinovna

St. Petersburg,

Introduction

The study of the characteristics of the structure both outside and intraogenian vessels of kidneys and lochanks is not only theoretical interest, but has about significant practical importance due to the wide distribution of various reconstructive operations carried out on the vessels of this body (plastic vessels, heterotopic auto precipitate, kidney omission, etc. d.).

Of particular importance are the details of the structure and topography of renal arteries and veins when performing alchoch milk transplant, as one of the promising methods for the treatment of chronic renal failure.

Kidney diseases cover an increasing number of people. In Russia, kidney disease has already about 4 percent of the population. According to statistics, the symptoms of the kidney disease are observed in women, however, the males have a kidney disease, as a rule, in heavy and running forms. Thus, it is difficult to overestimate the importance of knowledge about the individual variability of the structure of the kidney vessels and the technique of kidney operations.

Topographic and variant anatomy of kidney blood vessels

Arterial kidney channel. In the renal leg, the renal vein, behind it, and below are renal artery, behind the vessels - renal pelvis. This embodiment of the synthesis of the elements of the renal leg is found in 49% of cases. In 40% of cases, renal artery is located ahead of Vienna, in other cases there is a complex interweaving of the branches of the arteries and veins, located ahead of the loyal. The blood supply to the kidneys is carried out by renal arteries, separated from the abdominal aorta at an angle close to direct at the level of the lower half of the I lumbar or upper edge of the II of the lumbar vertebrae on 1-2 transverse fingers below the upper mesenteric artery. However, the right angle of renal artery deposition can range from 60 ° to 135 °, the average is 90 °, to the left - from 50 ° to 135 ° and on average is 85 °. Right renal artery is moving away from aorta by 1-2 cm lower than left. Renal arteries can be output at one level, this option of branching, according to various authors, is observed in 29.8-45% of cases. The diameter of the aorta is 23-26 mm, the diameter of the renal arteries is 4-8 mm. Topography of renal arteries is as follows. Right renal artery is longer, it crosses the legs of the lumbar diaphragm and a large lumbar muscle, located behind the lower hollow vein. It is covered with the head of the pancreas and the downward duodenal department. The length of the right renal artery ranges from 40 mm to 91 mm, on average, accounted for 65.5 mm. The left renal artery is shorter than the right, goes behind the left renal vein and often in the area of \u200b\u200bthe gate is located close to the spleen artery, passing at the top edge of the pancreatic tail. The length of the left renal artery is 35-79 mm, an average of 55.1 mm. Renal artery give extractuated and intraight branches. From both renal arteries, thin lower adrenal arteries are deployed, down - ureter branches. At the gates of the kidneys, renal artery, giving thin branches to the pelvis, cups and fibrous kidney capsule, are usually divided into front and rear zonal branches, then in the kidney gates divided into segmental arteries. The front branch forming ahead of the ahead of the vascular system, in 75% of people larger and supplies with blood most of the kidney parenchyma, its length is 5-35 mm, an average of 12.7 mm. It usually gives three segmental artery: upper pole, upper and lower proprietary. The rear branch, the length of which is 5-45 mm, on average 18.4 mm, forms a surfactant vascular system, the lower pole and maritious segmental arteries are departed from it. Zone, where the system of the front zonal branch of the renal artery is bordered by the rear, most often located on 1 cm of the star from the middle of the external edge of the kidney (Line of Condeke) (Fig. 1).

Fig.1 The length of the segmental arteries ranges from 20 mm to 58 mm, the longest of them is usually lower. In accordance with the intravenous distribution of the arteries by the international anatomical nomenclature, arterial kidney segments are allocated: the upper, top front, lower front, bottom and rear. The five-segmental structure of the kidney is most often found, but it has been established that the number of segments can vary from 4 to 12. The upper and lower segments are most constant, but in 10% of cases they are divided into front and rear. The number of front and rear segments can vary from 1 to 5. Segmental arteries with each other do not anastomize. From segmental arteries, branches called interdolevous. Interdole (inter-chain) arteries are lied in renal pillars and penetrate to the base of the renal pyramids, where they are divided into arc (arcate) arteries, which do not anatomize among themselves and, in turn, give interdollastic (international) arteries, radially branching and guided in cortical matter . Interdolt arteries in the cortical substance give intradollastic arteries, from which bringing arterioles heading into renal calf and giving the beginning of a wonderful capillary network forming vascular gloves. Clushing capillaries are assembled into the handling arterioles, which in the cortical nephrons in their diameter are about 2 times less than the arterioles. In this regard, blood pressure in the capillaries of the glomeruli of cortical nephrons reaches 70-90 mm. RT. Art. The endowing arteriols give the beginning of the secondary peritobular capillary network of the cortical and cerebral substance, and in the deep layers of the brainstant, they have a direct move (direct vessels). The share of glomerular and cortical peritabular arterial networks accounts for 86%, medullary - only 14% of the vascular channel of the kidneys. Especially it should be highlighted on the vascular system of Yuchstamedullar Nephron. About 80% of nephrons are almost entirely located in the cortical substance - these are cortical nephrons. The remaining 20% \u200b\u200bof nephrons are arranged in such a way that their capsules, proximal and distal departments lie in the cortical substance, and the loops of nephrons with rising and downstairs - in the brainstab. In the YuCstamedullary Nephron, the diameter of bringing and the enduring arteriol is about the same, and blood pressure in the glomeruli capillaries is not more than 40 mm. RT. Art. Blood mainly enters the arterioles in direct vessels and, bypassing the secondary network of capillaries, in direct venules. Naturally, the YUCSTAMEDULLARY Vascular system is a lighter and short way for blood flowing through the kidneys. YuCstamedullar arteriovenomous blood shunting is significantly in the conditions of intensive blood circulation and under a number of pathological conditions of the kidney.

Additional renal artery can occur in 30-35% of cases. It may be observed one (19.2%), two (2.1%) and three (0.7%) of additional renal arteries; Right more often than the left; Women more often than men. Additional renal arteries are more common to the bottom (15.7%) than the upper (3.8%) kidney segment. In relation to the kidney pellets, they are more often observed by the Kepenti from it (12%) than the for the post (5%).

Additional renal arteries are the most common type of renal vessels anomalies. It can be separated from aorta, renal, diaphragmal, adrenal, cranky, iliac arteries and are directed to the upper or lower kidney segment. Additional arteries to the lower kidney segment are very often disturbed by urine outflow from the kidneys. At the intersection of the urinary tract and the vessel in the wall of the ureter, irreversible sclerotic changes arise, leading to the development of hydronephrosis, pyelonephritis, the formation of stones. Violation of urodynamics is more pronounced if the addition vessel is located the Kepende from the urinary tract. Treatment is aimed at restoring the outflow of urine from the kidney and is to cross the addition vessel and due to the occurrence of the zone of ischemia - reducing the kidney, as well as resection of the sclerotically modified urinary tract zone and ureterooretero or ureteropelostomy. If the supplement vessel feeds most of the kidneys and its resection is not possible, resection of the narrowed part of the urinary tract and antsvasal plastic is produced.

Double and multiple renal arteries are such a type of anomalies in which the kidney receives blood supply from two or more equal to the caliber of the trunks. Multiple arteries can be detected in normal kidney, but more often combined with different kidney anomalies (dubbic, double, dystoped, horseshoe kidney, polycystic, etc.). Most often, the source of the formation of additional arteries is the abdominal aorta, however, options for the extinction of these vessels from the total iliac, outer or internal iliac, lumbays, sacratsy arteries, an enzyme barrel, an average adrenal and right colon artery are possible. Among the additional arteries, the kidneys is made to distinguish the addition and tasking. Additional artery is always included in the kidney parenchyma in its gate, whereas the arterier is called, penetrating the kidney substance in any area of \u200b\u200bthe surface of the organ outside its gate. One of the works devoted to the issues of additional arteries of the kidney is the work of this year. Yeremeeva (1962). In it, the author notes that the added arteries of 54.2% fell into the upper pole of the kidneys, and in 45.8% of cases, the lower pole of the kidney was incent of 45.8% of cases, while the added artery to the lower pole is 2-3 times larger in diameter than the top-pole. N.M. Inhibitory (1965, 1978) found additional arteries, blood supplying kidney, in 25.2% of observations. In this case, the diameter of these vessels was 0.3-0.4 cm. The addition arteries were 54.7%, and projection - 45.3%. On an excretory urogram, a narrowing is found in the form of a filling defect, S-shaped bending of the ureter, respectively, the projection of the vessel. According to Academician N.A. The blade is the presence of additional renal arteries initially cause periodic disorders of the passage of urine from the pellets due to the dyskinesia of the gluing-ureteral segment, and then lead to its scarsing damage due to continuous pressure on it. Stenosis of the addition renal arteries can also cause arterial hypertension. Accounting for the amount and level of extrusion of an additional vessel is also important in patients before surgery, since its intersection can cause vital bleeding.

Hundreds of suppliers are carrying medications from hepatitis with from India to Russia, but only M-Pharma will help you buy Sofosbuvir and Daclatasvir and at the same time professional consultants will answer any of your questions throughout the therapy.

Extreme renal artery

Extreme renal artery is the most frequent look of the anomalies of the renal vessels (84.6% among all the detected defects of the development of the kidneys and WPM). What is called "added renal artery"? In early work on. Lopatkin wrote: "To avoid confusion, each vessel from the aorta besides the main renal artery, it is advisable to call an additional, and the term" multiple arteries "use when it means all the supply of the kidney in such cases." In later publications, the term "additional artery" is not used at all, but apply the term "adding artery".

Such arterys "have less caliber compared to the main, go to the upper or lower segment of the kidneys, both from the abdominal aorta and from the main trunk of the renal, adrenal, cranky, diaphragmal or general iliac artery." There is no clear difference in the interpretation of these concepts. A in Ivanazyan and A.M. War-Yasenetsky strictly delimited the concepts of "multiple trunk", "added" and "tasking" of the kidney arteries. "Multiple trunk arteries" originate from the aorta and fall into the renal recess. The source of "added arteries" is common and outdoor. Current, medium adrenal, lumbar arteries. But they all fall through the renal recess. "Proprietary vessels" - penetrating the kidney outside its gate. Another interpretation of the anomalies of the number of renal arteries, we found in the "Campbell's Urology" manual (2002). In it S.B. Bauer, referring to a large number of works, describes "multiple renal arteries", - that is, more than one main, "anomalous or aberrant", - extending from any arterial vessel, except the aorta and the main renal artery, "added" - two or more arterial Barrel feeding one kidney segment.

Thus. We did not find a single terminological approach to the renal vascular anomalies of the quantity and therefore "added, or an additional, vessel" vessels that feed the kidney, besides the main arteries and derived from the aorta or any vessel, with the exception of the main artery. "Aberrant arteries" we called vessels separating from the renal artery and penetrating the kidney outside the renal sinus. Extreme renal artery can be separated from the aorta, renal, diaphragmal, adrenal, cereal, ileal vessels and are directed to the upper or lower kidney segment. There are no differences in the side of the arrangement of additional arteries.

Double and multiple renal arteries

Double and multiple renal arteries are the form of an anomaly of the renal vessels in which the kidney receives blood supply from two or more equal to the caliber of the trunks.

Solitary renal artery

The solitary renal artery that feeds both kidneys is an extremely rare view of the anomalies of the renal vessels.

Distopia of the renal artery deposition

Anomalies of the location - anomaly of the renal vessels, the main criterion in determining the type of kidney dystopia:

lumbar - with a low existence of the renal artery from the aorta;.
iliac - when disbeling from the general iliac artery;
pelvic - when disbeling from the internal ileal artery.

Aneurysm of renal artery

Anneurysm of the renal artery is the extension of the vessel due to the absence of muscle fibers in the wall in the wall and the presence of only elastic. This anomaly of the renal vessels is rare (0.11%). It is usually one-sided. Aneurysm can be located both extrarenal and intravenously. Clinically manifested by arterial hypertension diagnosed for the first time in youthful age. It can lead to renal arteries thromboembolism with the development of kidney infarction.

Fibromuscular stenosis

Fibromuscular stenosis is a rare vascular anomaly of renal vessels (0.025%). It represents a few alternative narrowings in the form of "thread beads" in the medium or distal third of the renal vessel arising from the overhaul of fibrous and muscle tissues in the renal artery wall. May be bilateral. It is manifested in the form of a difficult to correct arterial hypertension of bloodless flow. Treatment operational. The type of operation depends on the prevalence and localization of the vice.

Congenital arteriovenous fistulas

Congenital change of renal veins

Congenital change in renal veins can be divided into anomalies of quantity, shape and location, structure.

Anomalies of the right renal vein are mainly associated with doubling or triple. Left renal vein, besides increasing the quantity, may have an anomaly of the form and position.

Extreme renal vein and multiple buds of kidneys, according to some data, are found in 18 and 22% of observations, respectively. Usually, the addition renal veins are not combined with additional vessels. Additional veins, as well as arteries, can be crossed with a ureter, disturbing urodynamics and leading to hydronephortic transformation. Anomalies of the development of the left renal vein are more common due to the characteristics of embryogenesis. The right renal vein in the process of embryogenesis practically does not undergo changes. The left renal vein can pass in front, behind and around the aorta, do not fall into the lower hollow vein (extracasive loss and the innate absence of the order department).

Anomalies of the structure include renal vein stenosis. It can be permanent or orthostatic.

Earlier, the "gold standard" diagnosis of the anomalies of the renal vessels was angiography, but recently it became possible to diagnose these defects with less invasive methods - digital subtractive angiography, color ehodstallography, MSCT, MRI.

ilive.com.ua.

Causes of PA stenosis

The most frequent causes of the narrowing of the renal artery are atherosclerosis and the fibromed dysplasia of the artery wall. Atherosclerosis accounts for up to 70% of cases of the disease, the fibromuscular dysplasia is about one third of the cases.

Manifestations of spa

For a long time the spa may exist asymptomatic or in the form of benign hypertension. Bright clinical signs of the disease appear when the narrowing of the vessel reaches 70% . Among the symptoms are the most characters, secondary renal arterial hypertension and signs of violation of the parenchyma (decrease in urine filtration, intoxication of exchange products).

Among the complaints of patients with renal hypertension are marked:

Strong headaches, noise in the ears, flickering "flies" before your eyes;
Reduction of memory and mental performance;
Weakness;
Dizziness;
Insomnia or drowsiness during the day;
Irritability, emotional instability.

With the initial stage of the disease, the work of the kidneys is preserved, but Hypertension appears, which, however, is amenable to medication. Subcompensation is characterized by a gradual decline in kidney work, and in the decompensation stage, signs of renal failure are clearly traced. Hypertension in the terminal stage becomes malignant, the pressure reaches maximum numbers and not "comes off" by drugs.

SPA is dangerous not only by its manifestations, but also complications in the form of hemorrhages in the brain, myocardial infarction, edema of the lungs against the background of hypertension. Most patients are affected by the retina, its detachment and blindness is possible.

How to reveal the stenosis of the renal arteries?

The most informative diagnostic method is recognized arteriographyWhen with the help of contrasting radiography, the localization, the degree of stenosis pa and the impaired hemodynamics are determined. Perhaps also conducting Kt. and MRI.

Treatment of renal artery stenosis

Before proceeding with treatment, the doctor will recommend the patient to abandon the bad habits, begin to adhere to a diet with reduced salt consumption, limit liquid, fats and easily accessible carbohydrates. In atherosclerosis with obesity, weight should be reduced, since obesity can create additional difficulties in planning surgical intervention.

Cardioslelective beta blockers (Atenolol, Egilov, Bisoprolol);
Blockers of slow channels calcium (verapamil, nifedipine, diltiazem);
Alpha-adrenoblockers (prazozin);
Loop diuretics (furosemide);
Agonists of imidazoline receptors (Moxonidine).

Doses of drugs are selected individually, while it is desirable to prevent a sharp decline in pressure, and when selecting 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 nephrocarosis, hemodialysis or peritoneal dialysis in an outpatient basis is prescribed patients.

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 insufficiency of the organ with the defeat of one of the arteries;
Complications (pulmonary edema, unstable angina).

Types of interventions used in Spa:

Stenting and balloon angioplasty;
Shunting;
Resection and prosthetics of the renal artery section;
Removal of the kidney;
Transplantation.

Video: angioplasty and stenting - minimally invasive method of treatment SPA

The prognosis of the disease is determined by the degree of stenosis, the nature of secondary changes in the kidneys, the effectiveness and possibility of surgical correction of pathology. In atherosclerosis, a little more than half of the patients are returned to normal pressure indicators, and in the case of vascular dysplasia, surgical treatment allows it to restore it from 80% of patients.

sosudinfo.ru.

Stenosis of the renal arteries: causes of pathology

The narrowing of the lumen of peripheral arteries belong to the pathologies of the vascular system. Select various causes of stenosis. Atherosclerosis is considered the most common of them. As you know, in most cases it is observed in people who have an extra weight leading a sedentary lifestyle or suffering from diabetes. Atherosclerosis can develop for a long time. However, it is rarely diagnosed until the symptoms of the blockage of the arteries. To other reasons, stenosis include:

Fibromuscular dysplasia. Under this term implies a congenital genetic defect, as a result of which there is a lack of muscle fibers in the wall of the vessels. Pathology is observed in women of any age.
Aneurysm Arteries Kidney.
Tumors of peripheral vessels.
Congenital and acquired vasculitis.
The renal artery compression by neoplasms originating from the tissues of neighboring organs.

Listed reasons are found in rare cases. Therefore, their diagnosis is proceed only after the exclusion of atherosclerosis.

Mechanism for the development of hypertension

The main symptom of the stenosis of the kidney arteries is considered to increase hell. Therefore, with this clinical syndrome, the survey of the renal system is necessary. How are the stenosis of the renal arteries and arterial hypertension? 2 mechanisms participate in increased blood pressure:

Activation of the renin angiotensin system. The influence of these biological substances is developing the narrowing of the arteriole. As a result, the resistance of peripheral vessels increases. Thus, blood pressure in the arteries increases.
Aldosterone action. This hormone is produced in the cortical substance of adrenal glands. Normally, it is present in the body constantly. However, during the stenosis of the artery, its products are enhanced. Due to the excessive amount of aldosterone, fluid and sodium ions accumulate in the body. This, in turn, also causes an increase in hell.

As a result of chronic hypertensive disease, changes occur on the side of the cardiovascular system. The left ventricle is gradually hypertrophy and stretched. This is another cause of hypertension.

Stenosis of the renal artery: symptoms of disease

The narrowing of the kidney arteries leads by many consequences. Symptoms of stenosis manifests itself immediately, but only with pronounced occlusion. In this case, conservative treatment is not always effective. In addition to vascular disorders, the stenosis of the artery leads to ischemic changes in the kidney. As a result, the filtration and concentration function of the organ is suffering. Considering this, we can select 2 clinical syndrome, which develop during stenosis. The first is arterial hypertension. This syndrome is characterized by a number of clinical manifestations. Among them:

Enhance arterial pressure. It can be both episodic and constant. A special importance for diagnosis has an increase in diastolic blood pressure (more than 100 mm. RT. Art.).
The appearance of noise in the ears.
Dizziness.
Nausea, which has no connection with food.
Flashing "Flies" before your eyes.
Headache in the field of temples, forehead.
Irritability.

The second clinical syndrome is ischemic nephropathy. Due to the violation of the renal blood flow "nutrition" of the body is terminated. Especially dangerous bilateral stenosis of the renal arteries. Hypertension is a state that can be partially monitored by drugs. Unfortunately, the organ pronounced ischemia cannot be corrected using drugs. The symptoms of "oxygen starvation" of the kidney include: pain in the area of \u200b\u200bthe lower back, changes from urination. It is often observed a decrease in the amount of liquid released, the general weakness. In the urine there may be a blood admixture, a muddy precipitate.

Diagnostics

Only after the examination, you can make a diagnosis of "Stenosis of the renal arteries". Diagnosis of pathology includes the collection of complaints and anamnesis of disease, laboratory tests and instrumental methods. Most often, the leading syndrome is arterial hypertension, poorly permanent hypotensive therapy. Also, patients may complain about the unpleasant feelings in the lower back (from one or two sides), changing the nature of urination. The survey plan includes:

OAK and general urine analysis.
Blood chemistry. The disease can be suspected by raising the level of creatinine and urea.
Ultrasound kidneys.
Special samples: urine analysis on Nechiphenko, Zimnitsky.
X-ray-contrast study of vessels - renography.
Doppler photo of renal arteries.
Angiography.
CT and MRI.

Differential diagnosis

Considering that the hypertensive syndrome is the leading, renal artery stenosis differentiate with the pathologies of the heart, atherosclerosis of the aorta. Also, the symptoms can resemble the disease of the Incendian Cushing and the peochromocyth.

If the signs of ischemic nephropathy prevail, then the stenosis is differentiated with inflammatory pathologies of the kidneys. These include pyelo and glomerulonephritis. Also, such symptoms can be observed when sugar-diabetes complicated.

Conservative therapy with renal artery stenosis

Treatment of renal artery stenosis starts with conservative methods. With hypertension caused by narrowing renal vessels, a combination of several drugs is necessary. Preference is given to inhibitors of angiotensin-converting enzyme. But these drugs are not recommended to be taken with a pronounced atherosclerotic lesion of vessels. The combination is made up of the following groups of medicines:

Beta blockers. These include drugs "Metoprolol", "Coronal", "Bisoprolol".
Loop diuretics. The drug selection is the drug substance "Furosemid".
Calcium channel blockers. Among them are the "Verapamil" medicines, Diltiazem.

In addition, the patient must take drugs necessary for the treatment of the underlying disease (atherosclerosis, diabetes).

Surgical treatment of stenosis

Unfortunately, in most cases, hypotensive therapy is ineffective. In addition, decreased blood pressure only aggravates the ischemic nephropathy. Therefore, you have to resort to surgical intervention. Depending on the degree of lesion, the method of surgical treatment is chosen. Most often, artery is stenting, blood supplying kidney. If the entire surveillance of the vessel is blown up at a large extent, shunting is performed - replacement of the vessel section on the graft. With the death of the renal fabric, nephrectomy is produced.

Forecast after operational treatment of stenosis

Regardless of which side, there was a defeat (stenosis of the left renal artery or right), the forecast after the operation depends on the compliance with the recommendations of the doctor and the somatic state of the patient. Often surgical treatment allows you to achieve a positive result. After a few months in 60-70% of patients there is a normalization of blood pressure.

Complications of renal stenosis

Unfortunately, the stenosis of the kidney arteries is diagnosed only at the late development stage. Therefore, to neglect the recommendations of the doctor is impossible. After all, without proper treatment, formidable complications may develop. Among them is a myocardial infarction and ONMK against the background of a hypertensive crisis, acute and chronic renal failure. If it does not perform surgery in time, the patient may lose the body.

Prevention

Preventive measures include constant blood pressure monitoring if there are complaints about dizziness and noise in the ears, the refusal of smoking and alcoholic beverages. To avoid the progression of atherosclerosis, it is necessary to observe a special hypocholesterine diet, lead an active lifestyle. Some patients should be taken special preparations - statins.

fB.ru.

General

The essence of this disease is that cholesterol plaques accumulate in the blood. With blood flow, they apply along the vessels, stick on their walls. Blyka gradually clogs blood flow to the kidneys. The working capacity of the kidneys is directly dependent on the amount of blood, which flows to them. Therefore, if the person develops atherosclerosis, the body produces the renin hormone, which helps strengthen blood flow. As a result, the vessels are excessively filled with blood, stretching to the highest possible limits, thinned, become inelastic. In the started state of the sclerosis of the arteries, vessels are possible.

By itself, the blockage of blood vessels leads to renal failure, since the kidneys do not receive a sufficient amount of oxygen and the necessary substances. At the earliest stage of development of atherosclerosis, a person does not feel any deterioration in well-being. Symptoms are manifested only after the first complications. If arteriosclerosis is not treated, everything will end with the homing of the renal tissues.

The narrowing of the renal vessels symptoms. What diseases are striking the renal artery kidney artery and veins

Other questions from the category

Read also

Doperar kidney vessels (lecture on the diagnostic)

Building kidney vessels

Doperar kidney vessels

Doppler during renal artery stenosis

Direct signs of renal artery stenosis

Indirect signs of renal arterial stenosis

Table. Criteria of renal artery stenosis on ultrasound

Send a response

Renal artery

Structure

Stenosis

Aneurysm

Thrombosis

Vessels of kidneys

Renal artery diseases

Features and functions

Burning renal artery

Stenosis of the renal artery

Renal artery of the elderly

Diagnostics of changes

Stenosis of the renal arteries (PA): Causes, Signs, Diagnostics, How to Treat, Operation

Causes of PA stenosis

Manifestations of spa

How to reveal the stenosis of the renal arteries?

Treatment of renal artery stenosis

Video: angioplasty and stenting - minimally invasive method of treatment SPA

What diseases are affected by the renal artery

How the renal artery is arranged

Pathology

Diagnostic research

What is Stenosis

Aneurysm of vessels of kidneys

What is thrombosis and what it is dangerous

Renal artery: structure, functions, possible pathologies

Features and functions

Burning renal artery

Stenosis of the renal artery

Renal artery of the elderly

Diagnostics of changes

Stenosis of the renal arteries (PA): Causes, Signs, Diagnostics, How to Treat, Operation

Causes of PA stenosis

Manifestations of spa

How to reveal the stenosis of the renal arteries?

Treatment of renal artery stenosis

: angioplasty and stenting - minimally invasive method of treatment of spa

Additional artery of the right kidney

Additional kidney artery - what is it?

Views

Clinical picture

Diagnostics

Treatment

Symptoms of the presence of an extensive kidney arteries

Diagnostics

Treatment of anomaly

Extreme renal artery

Double and multiple renal arteries

Solitary renal artery

Distopia of the renal artery deposition

Aneurysm of renal artery

Fibromuscular stenosis

Congenital arteriovenous fistulas

Congenital change of renal veins

Causes of PA stenosis

Manifestations of spa

How to reveal the stenosis of the renal arteries?

Treatment of renal artery stenosis

Video: angioplasty and stenting - minimally invasive method of treatment SPA

Extreme renal artery

Double and multiple renal arteries

Solitary renal artery

Distopia of the renal artery deposition

Aneurysm of renal artery

Fibromuscular stenosis

Congenital arteriovenous fistulas

Congenital change of renal veins

Causes of PA stenosis

Manifestations of spa