The term microangiopathy summarizes a pathological change and reduced function of the small blood vessels where the exchange of substances with the surrounding body cells takes place. The disease primarily affects the capillaries of certain organs such as the eyes, kidneys and heart, with serious health consequences. The main causes of microangiopathy are metabolic disorders, high blood pressure and autoimmune diseases.

What is microangiopathy?

The blood vessel system consists of arteries that branch out and open into small arterioles. The arterioles further branch into capillaries that are not visible to the naked eye. Continuing the capillaries, they unite to form alveoli, which in turn unite to form macroscopic veins. Microangiopathy is a disease and functional impairment of blood vessels with a microscopically thin cross-section such as arterioles, capillaries and alveoli. See AbbreviationFinder for abbreviations related to Microangiopathy.

There is no precisely defined differentiation from macroangiopathy, in which the blood vessels with a larger cross-section (arteries and veins) are affected. Microangiopathy can affect any body tissue. The pathological changes in the vessels, depending on the cause, preferably occur in the fundus of the eye, in the kidneys, in the heart, in the brain and in the extremities. The walls of the capillaries can be changed in such a way that the necessary diffusion processes, i.e. a two-way exchange of substances, through the walls with the surrounding tissue cells is only possible to a limited extent or does not occur at all.

The functional restrictions are often due to deposits in the capillary walls, which – comparable to arteriosclerosis – make the capillary walls inelastic and unsuitable for gas and substance exchange. In rare cases, microangiopathies can also be caused by locally occurring occlusions of the upstream arterioles and arteries, so that there is no exchange of substances in the capillaries due to the lack of blood flow.

Causes

Microangiopathies are usually long-term consequences of other previous illnesses. The most important triggers are arterial hypertension, metabolic diseases such as diabetes mellitus and systemic autoimmune diseases. Arterial high blood pressure is usually itself caused by pre-existing conditions, which also have different effects on the vascular system. In the case of primary arterial hypertension in which there are no previous organic diseases, chronic stress is probably the most common cause.

Chronic stress leads to a sympathetic conversion of the metabolism to short-term calls for maximum physical performance such as flight or attack, without the physical potential ultimately being called upon. The stress hormones adrenaline and noradrenaline released by the sympathetic nervous system ensure constant vasoconstriction, resulting in increased blood pressure with corresponding effects on the capillaries of the blood vessel system.

Metabolic diseases can change the composition of the capillary membranes in the long term and impair their function. In diabetes mellitus, the retina in the area of ​​the macula, the point of sharpest vision, is usually affected.

Symptoms, Ailments & Signs

The symptoms and complaints of microangiopathy depend primarily on the affected organs and tissues and the resulting limitations in their functions. In the case of metabolic disorders caused by diabetes mellitus if the sugar balance is not artificially stabilized, the retina of the eye is often the first to be affected.

There is an initially mostly unnoticed disturbance of the exchange of substances on the retina. As the disease progresses, first the macula and later the entire retina are affected. In Europe and North America, diabetic retinopathy, which is due to microangiopathy, is the leading cause of blindness.

Diagnosis & disease progression

Possible diagnostic methods always refer to the organ tissue in which microangiopathy is suspected. While the fundus of the eye can be examined optically non-invasively in the case of retinopathy, a biopsy and a microscopic examination of the tissue samples taken are necessary for a proper clarification in the case of kidneys and liver.

In advanced stages, microangiopathy in the kidneys and heart can lead to renal insufficiency or cardiac insufficiency. Subcortical arteriosclerotic encephalopathy (SAE) also ultimately arises from a microangiopathy that initially leads to degradation of the myelin, the myelin sheaths of the neurons in the CNS.

In the advanced stage, motor disorders, urinary incontinence and neuropsychological disorders up to and including dementia set in. Only in the skin can the blood circulation in the final flow path (arterioles, capillaries, venules) be directly observed microscopically by using laser Doppler fluxmetry and staining with sodium fluorescein.

Complications

As a rule, the symptoms of microangiopathy depend on the organ affected and can vary greatly. However, this disease has a very negative impact on the organ and tissues affected by it. It is not uncommon for diabetes to cause problems in the eyes and retina, so that in the worst case the affected person can go completely blind.

Especially in young people, complete blindness can lead to severe psychological problems or depression and thus severely limit the quality of life. It is not uncommon for microangiopathy to develop into renal insufficiency. In the worst case, the affected person can die as a result of this and is dependent on dialysis or a donor kidney.

Heart failure can also occur and, in extreme cases, lead to the death of the patient. The treatment of microangiopathy usually always follows the underlying disease and tries to treat it. However, it cannot be generally predicted whether this will lead to success and a positive course of the disease. In many cases, life expectancy is significantly reduced by microangiopathy.

When should you go to the doctor?

Microangiopathy must always be examined and treated by a doctor. There is no self-healing. If left untreated, the disease can, in the worst case, lead to the death of the patient. The symptoms of microangiopathy depend heavily on the affected organ. As a rule, however, the patients suffer from diabetes and further eye problems. Vision deteriorates and vision problems or blurred vision occur. If these symptoms occur for no particular reason and, above all, are permanent, a doctor should be consulted. Microangiopathy can lead to blindness if symptoms are ignored. Kidney or heart problems also indicate this disease.

The disease can be diagnosed by a general practitioner. For further treatment, however, a visit to other specialists is necessary. It cannot generally be predicted whether this will lead to a positive course of the disease. Under certain circumstances, the life expectancy of the patient is limited and reduced by the microangiopathy.

Treatment & Therapy

Efficient treatment always depends on the underlying disease, because microangiopathy is usually the result and not the cause of the underlying disease. First and foremost, diabetes mellitus and primary arterial hypertension (high blood pressure) should be mentioned. Before or parallel to treatment of retinopathy or renal insufficiency, it should be ensured that the sugar balance is optimally adjusted and that the arterial blood pressure corresponds to normal values.

In some cases, the microangiopathy is caused by a change in the composition of the blood and a change in the flow properties associated with it. Here, too, it is advisable to first treat the causes of the change in the blood count. In the normal case, the microangiopathy also regresses when the flow properties of the blood return to normal.

In the case of one of the numerous autoimmune diseases, treatment is very difficult because the autoimmune reactions have to be curbed with medication and the body should not come into contact with the triggering substances if possible.

Outlook & Forecast

In general, early initiation of therapy leads to a favorable prognosis. Doctors can not only alleviate the acute symptoms, but also prevent chronic kidney failure. Furthermore, the following aspects favor the prospects: a young age, no significant comorbidities and a reduced degree of lesions. If these aspects are not present, there are usually no complications to be expected.

However, if a microangiopathy has already developed, the chances of recovery are unfavorable. Physicians can only try to inhibit or slow down progress. For this purpose, the blood sugar level in particular is adjusted by means of suitable therapies. Microangiopathy can be fatal if the course is unfavorable. Sometimes people also go blind, which can lead to mental health problems.

An illness always leads to limitations in everyday life. Patients must be closely monitored. The reduced function of the blood vessels must be counteracted. Overall, a mixed overall picture emerges. Sick people often have to deal with a reduced life expectancy. Starting treatment too late reduces the life span even further. However, today’s medical possibilities allow a largely symptom-free everyday life. Anyone who adheres to agreed rules significantly reduces their risk.

Prevention

Preventive measures to protect against microangiopathy consist essentially in avoiding underlying diseases such as diabetes mellitus and arterial hypertension. If other metabolic diseases are known that can trigger microangiopathy, the preventive measures consist of adjusting the affected metabolic values ​​to the normal values ​​as far as possible. In the presence of an inherited or acquired gene mutation that can trigger autoimmune reactions, there are no direct preventive measures. Usually, such abnormalities of the immune system are only discovered after the symptoms appear.

Aftercare

Microangiopathy leads to various symptoms and complications, all of which usually have a very negative effect on the quality of life and life expectancy of the person affected. A doctor should be consulted at the first signs and symptoms to prevent further complications. This clinical picture cannot heal on its own. In most cases, microangiopathy leads to various ailments of the internal organs.

It mainly leads to disorders in metabolism and also to diabetes. Those affected also often suffer from a need for fluids and also from weight loss. In the worst case, if left untreated, it can lead to complete blindness, which can no longer be treated.

The kidneys and heart are also affected by microangiopathy, which can lead to heart or kidney failure, which can also lead to death. Further treatment depends very much on the cause of the disease, so that a general prediction cannot usually be made. In many cases, the life expectancy of those affected is also reduced.

You can do that yourself

The measures affected by microangiopathy can take always depend on the underlying disease.

If the condition is caused by diabetes mellitus, the most important step is a change in lifestyle. If you have not already done so, the person affected must adapt their diet to the disease and do moderate exercise at the same time. Overweight people should strive to lose weight, because this is the only way to counteract diabetes mellitus and thus also microangiopathy in the long term. A doctor must optimally adjust the sugar balance and also check the arterial blood pressure.

If the microangiopathy is based on an autoimmune disease, drug treatment is required. Those affected should primarily take it easy and completely cure the underlying disease. Lifestyle changes are also recommended here, because a strengthened immune system is less susceptible to serious complications.

People suffering from microangiopathy require close monitoring by their family doctor. If secondary diseases or serious complications have already developed, a specialist must be consulted. The most important self-help measure is to have the reduced function of the small blood vessels checked regularly by a doctor and to ensure that the medication is optimally adjusted.