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Renal Artery Stenosis—When To Screen, What To Stent?

Renal artery stensosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Evidence from large clinical trials has led clinicians away from recommending interventional revascularisation towards aggressive…

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Articles of Interest

New tools in diagnosing renal artery stenosis

The prevalence of renal artery stenosis in the general population is not precisely known. In the late 1980s, however, Anderson, Blakemann, and Streeten, using the magnitude of blood pressure fall after saralasin administration as an indication of renovascular hypertension, found a prevalence of 3% of renovascular hypertension in 3520 unselected patients with arterial hypertension.

Renal artery stenosis in a single kidney patient: A case report

Renal Artery Stenosis (RAS) is a pathologic state that may lead to resistant hypertension, progressive decline in renal function, cardiac destabilization syndromes, recurrent heart failure, or acute coronary syndromes. Nowadays, RAS has two therapeutic methods, including drug therapy and balloon angioplasty (with or without stents).

Renal artery stenosis presenting as hypertension with hypokalemia

Hypertension with hypokalemia (spontaneous or drug-induced) suggests an aldosterone-mediated pathophysiology, typically primary aldosteronism (eponymously called Conn syndrome), which has a prevalence of 8% among patients with primary hypertension. However, not all instances of hypertension with excess aldosterone are caused by primary aldosteronism...

Renal Artery Stenosis Update

The current standard for revascularization in most patients is percutaneous transluminal angioplasty with stent placement across the stenosis. Angioplasty without stent placement is currently infrequently employed. Revascularization by surgical reconstruction is generally used only for patients with complicated renal artery anatomy or for patients who require pararenal aortic reconstructions for aortic aneurysms or severe aortoiliac occlusive disease.

Renal Artery Stenosis: Is It Common & Life Threatening?

In most cases, RAS does not exhibit any noticeable signs or symptoms...

Stages of renal artery stenosis: a hypothesis based on ultrasound findings: A narrative review

Based on experience with numerous RAS cases, RAS does not occur in a single step but is a multi-step inflammatory disease. It is hypothesized that RAS sonographically consists of early, intermediate, and late stages according to the degree of atherosclerotic change. Accordingly, RAUS can show various imaging features according to disease stage.

The Role of Renal Artery Stenosis

In many cases, RAS has no symptoms until it becomes severe. The sign of RAS is usually either high blood pressure or decreased kidney function, or both, but RAS is often overlooked as a cause of hypertension. RAS should be considered as a cause of high blood pressure in people who are aged >50 years when they develop high blood pressure or have a marked increase in blood pressure, have no family history of high blood pressure, and cannot be successfully treated with at least three or more different types of hypertension medications.

To stent or not to stent? This is the renal artery stenosis question

Results showed that the addition of renal-artery stenting to thorough multifactorial medical therapy did not contribute a significant clinical benefit with respect to the prevention of CVD events or renal function deterioration. Adverse CVD or renal events occurred in 35.1% of patients who received stenting and 35.8% of those on medical therapy alone (p=0.58). Thus, the authors concluded that renal artery stenting was not superior to optimal medical therapy alone for moderately severe ARAS.

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NIDDK

About 90 percent of RAS is caused by atherosclerosis... Most other cases of RAS are caused by fibromuscular dysplasia (FMD)—the abnormal development or growth of cells on the renal artery walls—which can cause blood vessels to narrow. Rarely, RAS is caused by other conditions.