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Renal artery stenosis

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Title: Renal artery stenosis  
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Subject: Urologic disease, Hypertension, Renovascular hypertension, Secondary hypertension, Digital subtraction angiography
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Renal artery stenosis

Renal artery stenosis
Classification and external resources
ICD-10 I70.1
ICD-9-CM 440.1
DiseasesDB 11255
MedlinePlus 001273
eMedicine med/2001
MeSH D012078

Renal artery stenosis is the narrowing of one or both of the renal arteries, most often caused by atherosclerosis or fibromuscular dysplasia. This narrowing of the renal artery can impede blood flow to the target kidney, resulting in renovascular hypertension – a secondary type of high blood pressure. Possible complications of renal artery stenosis are chronic kidney disease and coronary artery disease.[1]

Contents

  • Signs and symptoms 1
  • Cause 2
  • Pathophysiology 3
  • Diagnosis 4
  • Treatment 5
    • Atherosclerotic renal artery stenosis 5.1
    • Fibromuscular dysplasia 5.2
  • See also 6
  • References 7
  • Further reading 8

Signs and symptoms

Most cases of renal artery stenosis are asymptomatic, and the main problem is high blood pressure that cannot be controlled with medication.[2] Decreased kidney function may develop if both kidneys do not receive adequate blood flow,furthermore some people with renal artery stenosis present with episodes of flash pulmonary edema[3]

Cause

Renal artery stenosis is most often caused by atherosclerosis which causes the renal arteries to harden and narrow due to the build-up of plaque. This accounts for about 90% of cases with most of the rest due to fibromuscular dysplasia.[4] Fibromuscular dysplasia is the predominant cause in young patients, usually females under 40 years of age.[5]

Pathophysiology

The pathophysiology of renal artery stenosis, leads to changes in the structure of the kidney that are most noticeable in the tubular tissue.[6] If the stenosis is longstanding and severe the glomerular filtration rate in the affected kidneys never recovers and (prerenal) kidney failure is the result.

Changes include:[6]

Diagnosis

Assessment-of-the-kidneys-magnetic-resonance-angiography-renal-artery-stenosis-1532-429X-13-70-S2

The diagnosis of renal artery stenosis can use many techniques to determine if the condition is present, a clinical prediction rule is available to guide diagnosis.[7]

Among the diagnostic techniques are:

Treatment

A diuretic

Atherosclerotic renal artery stenosis

It is initially treated with medications, including diuretics, and medications for blood pressure control.[6] When high-grade renal artery stenosis is documented and blood pressure cannot be controlled with medication, or if renal function deteriorates, surgery may be resorted to. The most commonly used procedure is a minimally-invasive angioplasty with or without stenting. It is unclear if this approach yields better results than the use of medications alone.[14] It is a relatively safe procedure.[14] If all else fails and the kidney is thought to be worsening hypertension and revascularization with angioplasty or surgery does not work, then surgical removal of the affected kidney (nephrectomy) may significantly improve high blood pressure.[15]

Fibromuscular dysplasia

Angioplasty with or without stenting is the best option for the treatment of renal artery stenosis due to fibromuscular dysplasia.[16]

See also

References

  1. ^ "Renal Artery Stenosis".  
  2. ^ "Renovascular hypertension: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-08-17. 
  3. ^ Messerli, Franz H.; Bangalore, Sripal; Makani, Harikrishna; Rimoldi, Stefano F.; Allemann, Yves; White, Christopher J.; Textor, Stephen; Sleight, Peter (2011-03-15). "Flash pulmonary oedema and bilateral renal artery stenosis: the Pickering Syndrome". European Heart Journal: ehr056.  
  4. ^ "Renal Artery Stenosis" (PDF). NIH. 2014. Retrieved August 2015. 
  5. ^ "Fibromuscular Dysplasia: Practice Essentials, Background, Pathophysiology". 
  6. ^ a b c "Renal Artery Stenosis: Background, Pathophysiology, Etiology". 
  7. ^ Steyerberg, Ewout (2008-12-16). Clinical Prediction Models: A Practical Approach to Development, Validation, and Updating. Springer Science & Business Media.  
  8. ^ Granata, A.; Fiorini, F.; Andrulli, S.; Logias, F.; Gallieni, M.; Romano, G.; Sicurezza, E.; Fiore, C.E. (2009-10-12). "Doppler ultrasound and renal artery stenosis: An overview". Journal of Ultrasound 12 (4): 133–143.  
  9. ^ Protasiewicz, Marcin; Kądziela, Jacek; Początek, Karol; Poręba, Rafał; Podgórski, Maciej; Derkacz, Arkadiusz; Prejbisz, Aleksander; Mysiak, Andrzej; Januszewicz, Andrzej (2013-11-01). "Renal artery stenosis in patients with resistant hypertension". The American Journal of Cardiology 112 (9): 1417–1420.   – via ScienceDirect (Subscription may be required or content may be available in libraries.)
  10. ^ Talley, Nicholas Joseph; O'Connor, Simon (2013-09-20). Clinical Examination: A Systematic Guide to Physical Diagnosis. Elsevier Health Sciences.  
  11. ^ Ong, Yong Yau (2005-01-01). A Clinical Approach to Medicine. World Scientific.  
  12. ^ Sam, Amir H.; James T.H. Teo (2010).  
  13. ^ Attenberger, Ulrike I.; Morelli, John N.; Schoenberg, Stefan O.; Michaely, Henrik J. (2011-11-15). "Assessment of the kidneys: magnetic resonance angiography, perfusion and diffusion". Journal of Cardiovascular Magnetic Resonance 13 (1): 70.  
  14. ^ a b Jenks, S; Yeoh, SE; Conway, BR (5 December 2014). "Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis.". The Cochrane database of systematic reviews 12: CD002944.  
  15. ^ Fine, Richard N.; Webber, Steven A.; Harmon, William E.; Kelly, Deirdre; Olthoff, Kim M. (2009-04-08). Pediatric Solid Organ Transplantation. John Wiley & Sons.  
  16. ^ "Treatment of hypertension in patients with renal artery stenosis due to fibromuscular dysplasia of the renal arteries - Chrysant - Cardiovascular Diagnosis and Therapy". www.thecdt.org. Retrieved 2015-08-17. 

Further reading

  • Schrier, Robert W. (2010-01-01). Renal and Electrolyte Disorders. Lippincott Williams & Wilkins.  
  • "Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: a systematic review and meta-analysis". www.crd.york.ac.uk. Retrieved 2015-08-17. 
  • "Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta-analysis". www.crd.york.ac.uk. Retrieved 2015-08-17. 
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