Aneurysms of the renal artery - Causes, symptoms and treatment. MF.

Renal artery aneurysms are bag-like protrusions of the renal artery wall in which blood circulates. In its structure, the aneurysms of the renal artery are divided into true and false. If the true aneurysms consist of all layers of the artery, the false aneurysms are formed due to the prolapse of the muscular wall and the bulging of the mucous membrane exclusively.

Types of aneurysms and its rupture

Reasons for the formation of an aneurysm of the renal arteries

The most common cause of the formation of an aneurysm of the renal artery are systemic metabolic diseases that affect the structure and tone of arterial vessels. The most common such disease is atherosclerosis, which, affecting the intima of the arterial vessels, leads to a decrease in the tone of the latter and the formation of sack-like bulging in it.

A great value in the pathogenesis of this pathology is the pressure inside the arterial vessel itself. For example, if a person suffers from arterial hypertension accompanying atherosclerosis, then he has a risk of developing an aneurysm of the renal artery is much higher than that of any other patient.

In addition, there are other pathological conditions that can lead to the formation of an aneurysm of the renal artery. One type of false aneurysm can be formed with a penetrating wound of the wall of the renal artery. In this situation, the blood is poured from the bloodstream, but does not spread through the tissues, but rather is delayed by the latter. If at this time there is no thrombosis of the opening in the artery, the blood continues to circulate freely, not only inside it, but also in the conditioned cavity formed by adjacent tissues.

Symptoms of the renal artery aneurysm

As a rule, when has small dimensions of the renal artery aneurysm , they have no clinical manifestations and are completely asymptomatic. The first signs of the disease appear after the education reaches an impressive size or a rupture of its wall.

The symptomatic arising from the of the massive dimensions of the aneurysm arises from its pressure on neighboring anatomical formations. The closest to the renal artery is the ureter, a tube through which urine outflows from the kidney to the bladder. When the latter is pushed, the urine, lingering in the cavity of the kidney, leads to the enlargement of the renal pelvis and, accordingly, to the disturbance of the normal functioning of the organ. This immediately affects the general condition, as patients develop a state of uremia - a common infection of the blood with urinary toxins. In this case, marked general weakness, malaise, headaches and an unpleasant odor of acetone from the mouth. In the absence of adequate treatment, this condition may result in uremic shock and death.

In addition, quite often in patients with an aneurysm of the renal arteries, thrombi of these vessels are formed. This leads to a complete cessation of the blood supply to the kidney, which results in a kidney infarction and the same uremic shock.

More severe symptoms are noted with rupture of the renal artery aneurysm .It manifests itself in two clinical syndromes: painful and anemic. Patients report a sharp pain in the lumbar region, which appears, as a rule, after physical stress or trauma, albeit insignificant. Over time, it subsides, but there are complaints of shortness of breath, general weakness, malaise and severe persistent headaches. Such patients are apathetic, their skin and mucous membranes are pale.

If the patient has the above symptoms or has systemic atherosclerosis, he should immediately seek help from a urologist to exclude the diagnosis of an aneurysm of the renal artery.

Diagnosis of renal artery aneurysms

In this pathology, the general analysis of blood and urine remains absolutely "calm".The increase in the number of leukocytes can be seen only in the case of rupture of the aneurysm of the renal artery and inflammation of the adipose tissue of the retroperitoneal space.

You can visualize the formation using ultrasound. Its dimensions, as a rule, do not exceed one centimeter in diameter, and the very formation pulsates in time with contractions of the heart. When performing ultrasound in Doppler mode, it is possible to distinguish an aneurysm from the formation of any other origin. If the aneurysm of the renal artery is filled with blood with contractions of the heart, then malignant and benign tumors are supplied with blood vessels.

"Golden standard" in the diagnosis of aneurysms of the renal arteries is considered angiography. The essence of the method is that by means of a special catheter the water-soluble contrast is introduced into the aortic cavity. Further, with the blood flow, it spreads through the vessels and enters the renal arteries, completely filling the latter. If at this time to conduct an X-ray study of this anatomical site, one can see both the renal arteries themselves and the aneurysm formed.

Angiography: renal artery aneurysms

Treatment of renal artery aneurysms

In the absence of clinical symptoms and a stable hemodynamic picture with regard to the aneurysm of the renal artery, expectant management can be used. At the same time, ultrasound examination of the kidneys is performed every month during the year with the determination of the size of the aneurysm.

If in the course of such a study it is found that the aneurysm tends to increase or the patient has a general condition, then there is a need for an operative intervention. Previously, such operations were carried out only in the open way, when an aneurysm was bandaged at the base and excised. To date, such surgical interventions are not carried out, due to the active development of minimally invasive techniques. Now intravascular operations are actively used, such as obliteration of the aneurysm of the renal artery. For this purpose, a special catheter, similar to the one used for angiography, is inserted into the aneurysm cavity. After that, a special substance starts to be injected from it, which immediately freezes, "zamorovyvaya" aneurysm.

Advantages of this method is that it is carried out under local anesthesia and the patient can move around the department the next day after the operation, and after 3 days and completely discharged from the hospital. The only drawback of the operation can be considered its cost, as it costs the patient much more than regular open intervention.

Rehabilitation after illness

Rehabilitation after illness depends on what surgical intervention was performed. If it is a question of a minimally invasive technique, then patients need only antibacterial prophylaxis of secondary infection. For this, agents such as cephalosporin or ampicillin can be used, which are broad-spectrum antibiotics.

The postoperative period is much more difficult for patients who have undergone open surgical intervention. They need only one antibiotic therapy to recover. Together with this, physiotherapeutic treatment is actively used in the form of using magnetotherapy or UHF.

Features of nutrition and lifestyle

Since, in most cases, aneurysms of the renal artery are consequences of systemic atherosclerosis, correction of lifestyle, in the first place, should be aimed specifically at treating this disease. For this purpose, drugs that lower lipid levels in the blood can be used. Among the most well-known are rosuvastatin.

A very cautious way of life is necessary for those patients who refuse surgical intervention. At them the strong physical loading can become the reason of rupture of an aneurysm of a renal artery, therefore she is absolutely counter-indicative to such patients.

Treatment with folk remedies

As already mentioned, the only effective method of treating renal artery aneurysms is surgery. Since it is impossible to conduct an operative intervention in out-of-hospital settings, it is not necessary to speak about the effectiveness of treatment with folk remedies. All other attempts to cure the disease without an operation are unsuccessful.

Complications of renal artery aneurysms

The most dangerous complication of an aneurysm of the renal artery is hypovolemic shock, which arises from the rupture of the latter. In this case, the clinical picture depends on the amount of blood lost. If the amount of fluid lost during the rupture is not more than 500 ml, the patient may not have any clinical signs at all. If the amount of lost blood exceeds 2 liters, then this situation, as a rule, ends with the death of the patient.

Another serious complication of the aneurysm of the renal artery is hydronephrosis, an enlargement of the renal pelvis and thinning of its parenchyma. This occurs when the aneurysm of the ureter is squeezed, when urine can not flow freely out of the kidney cavity. In this case, patients complain of bursting pain in the lumbar region and a violation of urination. Quite often, hydronephrosis can be complicated by pyelonephritis. Then to the above complaints is added also an increase in body temperature.

With small ruptures of the aneurysm, when there is thrombosis of the artery defect, a retroperitoneal hematoma occurs. In the event that it dissolves, the patient's condition improves. If a secondary infection joins the hematoma, then suppuration of retroperitoneal fatty tissue occurs. In patients, complaints of an increase in body temperature, malaise, general weakness and pain in the lumbar region are noted. In the absence of adequate treatment, the condition can pass into a common blood infection, called sepsis. As with hypovolemic shock, high mortality is also recorded in sepsis.

Prevention of aneurysms of the renal arteries

Since the formation of an aneurysm of the renal arteries is strongly influenced by systemic atherosclerosis, primary prevention should be aimed specifically at treating this disease. All patients need to adhere to lipid-lowering diets with a low fat content in food. In addition, daily lifelong use of anti-atherosclerotic agents, such as rosuvastatin, is recommended.

Rev.the doctor the urologist, the sexologist-andrologist Plotnikov А.N.