Renal Arterial Aneurysm

　　The pathogenic factors of renal aneurysm may be related to the following aspects, which are specifically divided into three types:

　　1, Arterial wall structural injury

　　Severe atherosclerosis can lead to renal arterial intimal ulceration, degenerative changes in the middle layer, rupture of elastic fibers, and post-stenotic dilatation of the artery; congenital fibromuscular dysplasia and Ehlers-Danlos syndrome (EDS) related to weak elastic layer and increased vascular fragility can also cause aneurysm formation.

　　2, Injury

　　Blunt or penetrating injuries to the lumbar region, as well as iatrogenic injuries such as puncture biopsy, catheterization, etc., can cause damage to the integrity of the renal arterial wall, leading to the formation of an aneurysm. Aneurysms with aortic dissection and pseudoaneurysm are more common, especially in the right kidney, which is located lower and is more susceptible to trauma. Since the wall of pseudoaneurysm is composed of fibrous and inflammatory tissue, it is prone to rupture.

　　3, Autoimmune diseases

　　Collagen vascular disease, multiple arteritis, and immune reactions related to tuberculosis and syphilis can all trigger renal aneurysms. Common in intrarenal type, mostly multiple or bilateral onset.

　　About 1/4 of patients with renal aneurysm have hypertension, and they can also break into the renal vein to form a large renal arteriovenous fistula, which is less common. Renal aneurysms are rarely ruptured, and if they do occur, the condition is severe, with a high mortality rate.

　　Most renal aneurysms have no symptoms at all, especially in children. In elderly patients, symptoms are more likely to occur because the tumor mass often increases progressively, and symptoms such as pain, hematuria, and hypertension can occur. When a palpable pulsatile mass is felt in the abdomen during physical examination or a vascular murmur is heard in the abdomen, it should be suspected of the disease. Many aneurysms without specific symptoms are found due to hypertension.

　　The prevention of renal aneurysm mainly lies in the prevention of arterial disease. First, it should be actively prevented from the occurrence of atherosclerosis (primary prevention); if it has occurred, it should be actively treated to prevent the progression of the disease and strive for its reversal (secondary prevention); for those with complications, timely treatment should be given to prevent their deterioration and prolong the life of the patient (tertiary prevention). In addition, it should be avoided to cause various injuries and actively treat other primary diseases.

　　Renal aneurysms can be diagnosed by the following examinations, the specific content is as follows:

　　1, X-ray film:Approximately 1/4 of renal aneurysms can occur calcification, which is shell-like and wreath-like, mostly marginal calcification, located near the renal hilum, and most of the venous pyelography is normal.

　　2, Renal arteriography:This is the most reliable examination method, which can directly display the cystic bulging or fusiform dilation of the arterial wall, which can be solitary or multiple, large or small. When there is an arteriovenous fistula, early enhancement of the renal vein can be seen, and the feeding artery may be compensatorily thickened and twisted.

　　3, CT scan without contrast:Visible renal or para-renal slightly high-density mass, with clear and smooth borders, arcuate calcification visible at the edges, generally obvious enhancement on contrast-enhanced scanning, enhancement degree higher than renal parenchyma, close to the artery. Sometimes, the feeding vessels connected to the tumor mass can be seen, and the enhancement may be uneven when thrombosis occurs; when there is an arteriovenous fistula, the contrast agent should be fast in and out.

　　The general principle of diet for renal aneurysm patients is: eat easily digestible, high-vitamin diets. Pay attention to eating less and more often, and do not overeat. Avoid high-fat, high-sugar, and high-salt diets. Absolutely quit smoking and drinking. The specifics are as follows:
　　1. Foods that are suitable to eat include: foods rich in potassium, calcium, and low in sodium, such as potatoes, eggplants, kelp, and lettuce; plenty of fresh vegetables and fruits. Eat no less than 8 ounces of fresh vegetables and 2 to 4 ounces of fruit every day; appropriately increase the intake of seafood such as kelp, nori, and seafood fish; carbohydrate foods such as rice, congee, noodles, flour, glucomannan, soup, taro, soft beans; protein foods such as beef, lean pork, white meat fish, eggs, milk, dairy products (fresh cream, yeast milk, ice cream, cheese), soy products (tofu, natto, soybean powder, oil tofu); fat foods such as vegetable oils, a small amount of cream, salad dressing; foods rich in vitamins and minerals, such as vegetables (spinach, cabbage, carrots, tomatoes, lily root, pumpkin, eggplant, cucumber) and fruits (apples, oranges, pears, grapes, watermelons), seaweed, and fungi.
　　2. Renal aneurysm patients should first control their energy intake, advocate eating complex carbohydrates such as starch and corn. Eat less glucose, fructose, and sucrose, as these sugars are monosaccharides and are prone to increase blood lipids, which is not conducive to recovery. Secondly, limit the intake of fat. When cooking, choose vegetable oils, and eat more seafood, which can have a certain effect on preventing complications of aneurysm rupture. Finally, limit the intake of salt. Appropriate reduction of sodium salt intake can help lower blood pressure, reduce sodium and water retention in the body, and lower arterial pressure.

　　The traditional treatment for renal aneurysm is surgical operation, but it is also a good indication for interventional embolization. Interventional therapy has the characteristics of minimal trauma, significant effect, and simplicity and safety. It has partially replaced surgical methods and become the first-line treatment for renal aneurysm. However, in the following situations, it is recommended to perform aneurysm resection: uncontrolled hypertension; incomplete calcification; aneurysm larger than 2.5cm; female patients who may be compressed and ruptured during pregnancy; aneurysm is progressively increasing; the presence of arteriovenous fistula, etc.