Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Narrowing of the kidney arteries is more common in individuals 50 years of
age and older. It is estimated that some degree of narrowing (greater than 50%)
is found in about 18% of adults between 65-75 years of age and 42% of those
older than 75 years of age. This may be due to the fact that atherosclerosis is
more common in this age group.
In younger patients, the narrowing of the renal artery usually is due to the
thickening of the artery (fibromuscular dysplasia) and it is more common in
women than men.
It is estimated that renal artery stenosis accounts for approximately 1% of
mild to moderate cases of high blood pressure. It may be responsible for more
than 10% of cases of severely elevated or difficult to treat high blood pressure
(hypertension).
What are the symptoms of renal artery stenosis?
In general, renal artery stenosis is not associated with any obvious or
specific symptoms. Suspicious signs for renal artery stenosis include:
high blood pressure that responds poorly to treatment;
severe high blood pressure that develops prior to age 30 or greater than
age 50;
an incidental finding (discovered through routine tests or tests performed
for another condition) of one small kidney compared to a normal sized one on the
other side.
Typically, unilateral (one-sided) renal artery stenosis may be related to
high blood pressure whereas bilateral (two-sided) renal artery stenosis is more
often related to diminished kidney function.
What problems does renal artery stenosis cause?
When the circulating blood volume becomes depleted as a
result of, for example, dehydration or bleeding, the blood flow to the kidneys
is likewise reduced. The normal physiologic reaction to a decrease in blood flow to the
kidneys is a complex hormonal response by the kidneys, called the
renin-angiotensin-aldosterone system.
This hormonal system is activated as a defense against
low blood pressure and low circulating blood volume. The kidney senses a
possible decrease in the circulating blood when blood flow through these vessels
is reduced. As a result, there are increased blood levels of the hormone
angiotensin 2, which causes
narrowing of the small blood vessels in the kidneys.
This, together with increased blood aldosterone levels
(another hormone), promotes salt retention by the kidneys, and works to maintain
blood pressure and restore blood volume. Accordingly, this hormonal system is
protective in response to reduced circulation of blood to the kidneys that is caused either by
volume depletion, as described, or by reduced blood pressure.
This otherwise normal hormonal response can become
abnormal (pathologic) when
the decreased blood flow to the kidneys results from a narrowing of diseased
renal arteries. In this situation, the kidneys receive less blood flow, which
then signals a sense of depletion of the circulating blood volume, despite the
fact that the blood volume is actually normal. So, the diminished renal blood
flow, by stimulating the production of angiotensin 2 and aldosterone, can lead
to an abnormal increase of blood pressure (renovascular hypertension).
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the low flow of blood through the arteries and veins. Some of the symptoms of low blood pressure include light-headedness, dizziness, or even fainting if not enough blood is getting to the brain. Diseases and medications can also cause low blood pressure. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidneys; the organs do not function normally and may be permanently damaged.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Vasculitis is a general term for a group of uncommon diseases which feature inflammation of the blood vessels. Each form of vasculitis has its own characteristic pattern of symptoms. The diagnosis of vasculitis is definitively established after a biopsy of involved tissue demonstrates the pattern of blood vessel inflammation. Treatment is directed toward decreasing the inflammation of the arteries and improving the function of affected organs.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
High blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
Smoker's lung photo essay is a collection of pictures and microscopic slides of lung disease caused by cigarette smoking. Smoker's lung refers to the diseases and structural abnormalities in the lung caused by cigarette smoking.
The risks for developing type 2 diabetes include family history, ethnicity, birth weight, metabolic syndrome, and obesity. Warning signs pointing to an increased risk for developing type 2 diabetes include irregular menstruation, impaired fasting glucose, inflammatory markers, and other risks. Gestational diabetes is also a risk factor for developing type 2 diabetes later in life. Prevention of type 2 diabetes can be achieved through a healthy diet (Mediterranean diet), exercise, weight control, not smoking, and medication.
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