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Pathology for Urologists

Renovascular Hypertension: Atherosclerotic Disease


Image A
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Image B
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  • Renovascular hypertension is defined as hypertension resulting from eccentric atheromatous narrowing of renal artery lumen.
  • Represents 2-5% of hypertensive cases, but is important because it is curable.
  • Two major causes: atherosclerosis and fibromuscular dysplasias.
  • Atherosclerosis is the most common cause (60-70%) of renovascular hypertension affecting mainly older individuals.
  • More common in male.
  • Has higher incidence in elderly and diabetics.
  • Gross:
    • Atheromatous plaque at origin of renal artery from aorta (involved ~50%).
    • May show recent thrombosis.
    • Kidney is small (usually <1/2 normal weight).
  • Bilateral in ~60% of cases.
  • Histology:
    • Proliferation of smooth muscle (myointimal) cells in arterial intima (image A).
    • Lipid deposition (cholesterol clefts), histiocytic infiltration (foam cells), necrosis and fibrosis result in narrowing of arterial lumen (image B).
  • Surgical removal results in cure rate of 60-75% of patients.
  • With 75% narrowing, ischemic renal disease may occur.

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