| Because your hypertensive patient has an | | | | A physician uses excretory urography to identify |
| increased risk of developing renal disease, monitor | | | | the absence or presence of lesions, areas of |
| his laboratory results for the following. | | | | restricted blood flow, and areas of vascular |
| Stage I: Diminished Renal Reserve | | | | occlusion. He also may use renal arteriography to |
| * reduced kidney function with no accumulation of | | | | evaluate renal blood flow. Excretory urography |
| metabolic wastes | | | | and renal arteriography require the use of |
| * mild elevation in blood urea nitrogen (BUN) and | | | | contrast media, placing your patient with renal |
| creatinine levels | | | | insufficiency at risk for worsening kidney function. |
| Stage II: Renal Insufficiency | | | | Treatment for Peripheral Vascular Disease |
| * mild accumulation of metabolic wastes | | | | The treatment of peripheral vascular disease may |
| * elevated BUN, creatinine, uric acid, and | | | | include drug therapy, surgery, or both. If your |
| phosphorus levels | | | | patient has peripheral artery occlusive disease, the |
| * anemia | | | | physician may prescribe pentoxifylline, which is the |
| * mild hyperkalemia | | | | only effective drug for treating the condition. |
| * reduced ability to concentrate urine | | | | Pentoxifylline increases erythrocyte flexibility and |
| Stage III: End-stage Renal Disease | | | | reduces blood viscosity, thus increasing the |
| * excessive accumulation of metabolic wastes | | | | oxygenated blood supply to the ischemic muscle. |
| * severely elevated BUN, creatinine, potassium, | | | | The physician may prescribe an antihypertensive |
| and phosphorus levels | | | | drug to control your patient's blood pressure. If |
| * decreased sodium and calcium levels | | | | your patient undergoes arterial bypass surgery |
| * decreased hemoglobin level and hematocrit | | | | for peripheral vascular disease, his physician also |
| * fluid retention | | | | may prescribe aspirin and warfarin to maintain |
| A physician uses renal ultrasonography, excretory | | | | graft patency. |
| urography, and renal arteriography to diagnose | | | | To treat peripheral vascular disease, a surgeon |
| renal disease. Renal ultrasonography helps the | | | | may perform patch graft angioplasty. In this |
| physician visualize renal structures to evaluate the | | | | procedure, the surgeon opens the occluded artery |
| integrity of tissues and vessels. This procedure is | | | | and removes the atherosclerotic plaque. Then he |
| safe for patients with renal insufficiency because | | | | places a patch over the opening to widen the |
| it doesn't use contrast media. | | | | vessellumen. |