Renal artery stenosis

From Ganfyd

Renal artery stenosis (RAS),is the narrowing of one or both renal arteries or their branches and causes about 5% of chronic kidney disease.

Suspect if hypertension: Onset > 160/100 mm Hg after 50 years of age With no family history of hypertension Associated with renal impairment (especially if worsens after sartin or ACE inhibitors) Drug resistant

Causes

1. Atheroma
   • Associated with more than doubling risk of coronary artery disease, stroke and peripheral vascular disease
2. Fibromuscular dysplasia
3. Other causes are rare

Treatment

• Stop aggravating drugs such as ACE inhibitors
• In fibromuscular dysplasia balloon angioplasty
• Best management of atherosclerotic RAS unclear
  • Medical treatment directed at controlling BP and atheroma (statins and aspirin)
  • Paradoxically there is now evidence that mortality is lower in those with RAS treated with ACE inhibitors at a risk of doubling acute renal failure hospitalisations^[1]
  • Revascularisation can be considered if medical therapy fails

References