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Contemporary
Approaches toRenal
Vessels Disorders
Updates and Management
Strategies
AdrianCovic
AlexandruBurlacu
Editors
Contemporary Approaches to Renal Vessels
Disorders
Adrian Covic • Alexandru Burlacu
Editors
Contemporary Approaches
to Renal Vessels Disorders
Updates andManagement Strategies
ISBN 978-3-031-71929-5 ISBN 978-3-031-71930-1 (eBook)
https://doi.org/10.1007/978-3-031-71930-1
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2024
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.
Editors
Adrian Covic
Clinical Hospital “Dr. C.I. Parhon”
Iaşi, Iasi, Romania
University of Medicine and Pharmacy
“Gr. T. Popa”
Iasi, Romania
Alexandru Burlacu
Institute of Cardiovascular Diseases
“Prof. Dr. George I.M.Georgescu
Iasi, Romania
University of Medicine and Pharmacy
“Gr. T. Popa”
Iasi, Romania
This endeavor is lovingly dedicated to our
beloved wives, whose unwavering support
and encouragement have been our greatest
strength, and to our precious children, who
inspire us every day.
Adrian Covic and Alexandru Burlacu
vii
Foreword
Arterial hypertension is a major risk factor for cardiovascular mortality, with an
extremely high prevalence among patients with renal disease. The presence of
hypertension accelerates the progression of renal damage, while renal disease itself
can lead to hypertension, creating a harmful vicious cycle. Both conditions syner-
gize to promote the development and progression of cardiovascular disease.
Despite clear evidence, the role of renal vasculature in these processes is often
underestimated and poorly understood. Beyond the activation of the renin–angio-
tensin system and the autonomic nervous system, recent research has uncovered
new biochemical and molecular mechanisms underlying kidney damage in hyper-
tension. Damage to the renal microcirculation has been associated with increased
oxidative stress, endothelial dysfunction, and a chronic state of subclinical infec-
tion. Understanding these mechanisms, which underlie hypertensive nephroangio-
sclerosis, has led to new research to control these factors.
In addition to microcirculation, diseases and abnormalities of the renal large
arterial and venous vessels can lead to pathological conditions that threaten sys-
temic health. Signicant advances have been made in the early identication and
treatment of these conditions. The approach to atherosclerotic nephrovascular dis-
ease has evolved, emphasizing the optimization of pharmacologic intervention and
reserving revascularization for selected cases, in line with personalized medicine
principles based on the clinical condition of individual patients.
Kidney transplantation and its associated renal vascular issues are also critical
topics. Kidney transplantation is often considered the treatment of choice for eligi-
ble patients with kidney failure, offering numerous advantages over dialysis, such as
decreased mortality risk, longer life expectancy, and improved quality of life.
However, vascular complications in renal transplantation, including transplant renal
artery stenosis, thrombosis, and biopsy-induced vascular injuries, remain relatively
common and can lead to allograft damage. Understanding these complications and
the perioperative vascular considerations is essential for improving patient out-
comes and graft survival.
Finally, recent guidelines from hypertension scientic societies have renewed
the importance of renal denervation techniques for treating resistant forms of
viii
hypertension, based on the latest randomized trials. Additionally, new evidence sug-
gests that renal denervation may provide benets beyond treating resistant hyper-
tension, impacting renal, arrhythmic, and metabolic diseases.
This book, coordinated by two experts in the eld, Prof. Adrian Covic and Prof.
Alexandru Burlacu, addresses all these topics, providing a comprehensive overview
of subjects that are often insufciently known and considered. It aims to be a valu-
able resource of knowledge and clinical intervention, not only for nephrologists but
also for cardiologists and physicians dealing with metabolic diseases.
SimonettaGenovesi
Dipartimento di Medicina e Chirurgia
Università di Milano-Bicocca
Milano, Italy
Direttrice della Scuola di Specialità di
Nefrologia di Milano-Bicocca
Milano, Italy
Istituto Auxologico Italiano, IRCCS
Milano, Italy
Foreword
ix
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Alexandru Burlacu and Adrian Covic
The Renal Vascular System: Anatomical Considerations and
Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Cristina Furnica, Raluca Ozana Chistol, Elena Sapte, and Grigore Tinica
Renal Vascular Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Cristian Mornos and Adrian-Sebastian Zus
Contrast Induced Acute Kidney Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Simona Mihaela Hogas and Adrian Covic
Renal Artery and Vein Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Bogdan Obrișcă and Gener Ismail
Renovascular Disease: Updated Management Protocols . . . . . . . . . . . . . . . 87
Philip A. Kalra, Áine DeBhailis, and Darren Green
Arterial Hypertension and Renal Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Laura Vasiliu, Anca Diaconu, Radu Sascau, and Cristian Statescu
Renal Artery Denervation: Evidence, Guidelines, and Major Trials . . . . . 113
Paula Cristina Morariu, Alexandru Florinel Oancea, and Mariana Floria
Beyond Blood Pressure: Expanding the Use of Renal Denervation
in Diverse Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Alexandru Burlacu and Crischentian Brinza
Kidney Transplantation and Renal Vascular Issues . . . . . . . . . . . . . . . . . . 147
Titus Andrian, Luminita Voroneanu, and Adrian Covic
Contents
1© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2024
A. Covic, A. Burlacu (eds.), Contemporary Approaches to Renal Vessels
Disorders, https://doi.org/10.1007/978-3-031-71930-1_1
Introduction
AlexandruBurlacu andAdrianCovic
Abstract Advancements in nephrology have signicantly enhanced the under-
standing of the renal vascular system and its pivotal role in health and disease. This
book presents a comprehensive exploration of renal vascular physiology, patholo-
gies, diagnostic techniques, and therapeutic interventions, aiming to provide an
essential resource for healthcare professionals and researchers.
Keywords Nephrology · Renal vascular system · Renal vascular physiology ·
Diagnostic techniques · Therapeutic interventions · Hypertension · Hypertensive
renal damage · Endothelial dysfunction · Imaging · Renal disease
Advancements in nephrology have signicantly enhanced the understanding of the
renal vascular system and its pivotal role in health and disease. This book presents
a comprehensive exploration of renal vascular physiology, pathologies, diagnostic
techniques, and therapeutic interventions, aiming to provide an essential resource
for healthcare professionals and researchers.
Hypertension remains one of the most prevalent and challenging health issues
worldwide. The interplay between hypertension and renal vasculature involves sev-
eral complex mechanisms, including the renin-angiotensin-aldosterone system
(RAAS) and the sympathetic nervous system (SNS). Hypertensive renal damage
often results in conditions like nephrosclerosis and glomerular injury, which, in
A. Burlacu (*)
Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, Iasi, Romania
University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
e-mail: alexandru.burlacu@umasi.ro; adrian.covic@umasi.ro
A. Covic
University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
Nephrology Clinic, Dialysis and Renal Transplant Center– ‘C.I.Parhon’ University Hospital,
Iasi, Romania
e-mail: adrian.covic@umasi.ro
2
turn, can worsen systemic blood pressure control. We investigated the latest research
on endothelial dysfunction, oxidative stress, and inammation as key factors in the
progression of hypertensive renal damage, providing insights into novel therapeutic
targets and treatment strategies.
Renal vascular anomalies, such as renal artery aneurysms and arteriovenous s-
tulas, present signicant diagnostic and therapeutic challenges. In the present book,
we analyzed advanced imaging techniques, which have greatly improved the accu-
racy and early detection of these anomalies. Additionally, the shift from traditional
surgical methods to minimally invasive procedures, such as endovascular stenting
and coil embolization, is thoroughly examined, highlighting their benets in reduced
risk and quicker recovery times.
The management of renovascular diseases has evolved with signicant advance-
ments in pharmacological and interventional therapies. Drugs targeting the RAAS
and SNS have proven effective in controlling hypertension and slowing the progres-
sion of renal disease. This work reviews the efcacy of these pharmacological inter-
ventions, as well as the latest interventional techniques, including renal artery
stenting and embolization, which offer less invasive alternatives to traditional sur-
gery. The advancements have not only improved patient outcomes but also provided
new avenues for treatment in cases where conventional methods are less effective.
Also, we provided an in-depth look at the latest diagnostic tools and techniques
that have revolutionized the eld. High-resolution imaging modalities, such as CT
and MR angiography, allow for detailed visualization of the renal vasculature,
enabling early and precise detection of anomalies. The clinical implications of these
advancements are discussed, with case studies illustrating their practical applica-
tions in diagnosing and managing renal vascular diseases.
Ongoing research in renal vascular biology continues to uncover new insights
into the mechanisms underlying renal vascular diseases. Genetic studies are shed-
ding light on hereditary factors that contribute to these conditions, while advance-
ments in molecular biology are identifying new biomarkers for early detection and
monitoring. We analyzed the potential of personalized medicine, which tailors ther-
apeutic approaches based on individual genetic proles, promising more effective
and customized treatments. Emerging technologies and innovative research further
advance our understanding and management of renal vascular health.
The exploration of the renal vascular system presented in this book aims to
enhance our awareness of its complexities and its interplay with systemic health. By
integrating current knowledge with innovative research and clinical practices, this
book provides a comprehensive resource for healthcare professionals and research-
ers dedicated to improving patient outcomes in renal vascular health. Through con-
tinued investigation and the application of advanced therapeutic strategies, the
future of renal vascular medicine holds signicant promise for addressing the chal-
lenges of tomorrow.
A. Burlacu and A. Covic