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Cure regimen for RAS

When the doctor told her, “You are going to be a mother soon”, tears came streaming down Seema’s face and husband Rohit made futile attempts to console her. Recovering from the initial shock, they took turns to recount to the doctor their traumatic experience of three miscarriages and how they had relocated from another city to run away from the harrowing memories.

The doctor took Seema’s case history and prescribed a few blood tests after recording her “inordinately high” blood pressure. When the tests showed an elevated serum creatinine — a metabolic waste normally excreted by the kidney — he zeroed in on the diagnosis of renal artery stenosis (RAS), one of the principal causes of systemic hypertension. RAS was the culprit that caused ecclampsia or sudden rise of blood pressure, leading to miscarriage.

As the name suggests, the renal artery, or the artery supplying blood to the kidneys, becomes progressively occluded in this disease. This invites a multitude of related complications, like uncontrolled hypertension, heart problems, renal failure and disturbed balance of different chemicals.

Out of 100 patients with a history of high blood pressure undergoing coronary angiography, 20 are found to suffer from RAS, which usually hits patients above 50. “Some patients frequently show wild fluctuations in blood pressure and symptoms of sudden onset of acute renal failure,” says Sunil Lhila, consultant interventional cardiologist, Apollo Gleneagles Hospitals.

Patients undiagnosed and untreated face “unexpected problems” when undergoing a bypass procedure, adds Aftab Khan, consultant interventional cardiologist at the same hospital.

“It should be mandatory to check for RAS in patients with a history of high BP undergoing coronary angiogram, which would reduce post-operative complications to a large extent,” stresses Lhila.

The dreaded condition doesn’t strike the aged alone, maintain doctors. Originating from a disease called fibro-muscular dysplasia, RAS can often endanger pregnancy with conditions like ecclampsia or pre-term labour and is the main culprit behind unfortunate miscarriages.

“It’s sad that these mishaps occur at a time when a simple procedure can reopen the occluded renal artery,” observes Lhila. “We have performed at least 30 renal artery angioplasty and stenting till now, and all the patients are doing fine.”

Angioplasty and stenting in the renal artery is no different from coronary artery intervention in terms of hospital stay or recovery. A safe, minimally invasive procedure, it can be performed without a hitch on elderly patients, those with severe hypertension, and with other conditions like diabetes or heart ailments, and those with a single kidney.

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