Extrarenal Macrovascular Disease

The kidney is also susceptible to the accelerated atherogenic process affecting the blood vessels. Acute onset of hypertension or loss of BP control in a known hypertensive patient should suggest a vascular etiology. Accumulation or rupture of an atherosclerotic plaque in a renal artery may cause renal ischemia and secondary hyperaldosteronism through the renin response. Rarely, diffuse atherogenesis in the diabetic aorta can result in cholesterol emboli traveling into the renal microvasculature. The urine sediment can become active, indicative of glomerulonephritis.

The diagnosis of extrarenal macrovascular disease is also evident clinically by the appearance of distal microinfarcts in the toes. The renal arteries can be examined for stenosis using Doppler ultrasound. Magnetic resonance angiography (MRA) can provide high-resolution imaging of stenotic plaques and quality of the great vessels without the risks of contrast agents. Advances in endovascular surgery with stent placements have simplified renal artery repair and stabilized the aorta in the face of aneurysmal dilation and threatening rupture, which might be signaled by release of cholesterol-laden plaques. Early treatment with statins is thought to stabilize plaques and preclude devastating vascular complications.

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