fumarates and Renal-Artery-Obstruction

Cyr61 is a member of the CCN family of proteins that is expressed in atherosclerotic lesions and regulated by angiotensin II. It is unknown whether renal artery stenosis (RAS) increases Cyr61 expression. Male ApoE

Topics: Amides; Amlodipine; Angiotensin II; Animals; Antihypertensive Agents; Apolipoproteins E; Blood Pressure; Cysteine-Rich Protein 61; Fumarates; Gene Expression Regulation; Humans; Hypertension; Irbesartan; Mice; Mice, Knockout; Renal Artery; Renal Artery Obstruction

Topics: Amides; Calcium Channel Blockers; Female; Fumarates; Humans; Hypertension; Hyponatremia; Middle Aged; Nifedipine; Renal Artery Obstruction; Renin; Syndrome; Thirst

This case represents an individual with accelerating hypertension and declining kidney function associated with atherosclerotic renal artery stenosis. Key features include loss of GFR (reaching stage V CKD) during intensified antihypertensive drug therapy including agents that block the renin-angiotensin system and failure to appreciate the extent to which moderate renal artery stenosis was affecting his better kidney. Interpretation of duplex ultrasound studies was complicated by a discrepancy between near-normal peak systolic velocities and markedly abnormal segmental arterial waveforms. It was essential to recognize that both kidneys were abnormal and focus on recovery of perfusion to the better of these kidneys. Successful revascularization of one kidney allowed major improvement in GFR and BP control.

Topics: Aged; Amides; Antihypertensive Agents; Atherosclerosis; Atrophy; Blood Pressure; Carbazoles; Carvedilol; Disease Progression; Drug Therapy, Combination; Fumarates; Glomerular Filtration Rate; Humans; Hypertension; Kidney; Kidney Failure, Chronic; Male; Propanolamines; Renal Artery Obstruction; Stents; Teaching Rounds