肾动脉狭窄支架术现状课件.ppt

Renal stenting in renal artery stenosis----contented and uncontented 肾 动 脉狭窄支架术  ARAS 90% FMD 10% Haemodynamics: 　50%　Renal perfusion pressure reduction 　70%　RPP75-85mmHg, autonomic regulation lose　 Pathology: Glomcrulus：arteriosclerosis, mesenterium proliferation， Nephric tubule：epithelial cells denudation、apoptosis,Focal necrosis， Renal interstitium：Inflammatory cell infiltration、fibrocyte proliferation End stage ：renal atrophy Develop to total occlusion within 5 years 15% Deterioration gradually within 5 years 10-20% Develop to ESRD annually 5-15% 3-year mortality in Pt. with ESRD on dislysis 50% Survival of ARAS Pt. with ESRD on dislysis: 5-year 18% 10-year 5% Renal function: improement： GFR increse 15% /Scr decrease 0.2mg/dL stable： GFR change15% / Scr change 0.2mg/dL ineffective： GFR decrease 15% / Scr increase 0.2mg/dL benefit： Improement or stable Blood pressure: cure： SBP140mmHg and DBP90mmHg, without any anti-hypertension drugs， improement： SBP140mmHg and DBP90mmHg, or, DBPdecrease 15mmHg with similar or less anti-hypertension drugs ineffective： BP change not meet the above standard benefit： cure and improvement nephron redunction volume-dependent hypertension：(Bil RAS/renal dysfunction) renin-dependent hypertension：(uni RAS) sympathetic nervous system vasoactive substance secreted from kidney：natriuretic hormone vasopressin Renal arteriolar sclerosis in benign hypertension Early stage：hyalinization in afferent glomerular arteriole and arteria interlobulares advanced stage：glomerulus, nephri