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07-SEPTEMBER-2008 03:17:44 - artery stenosis Renal artery stenosis Classification and external resources Renal artery is #3 ICD-9 440.1 DiseasesDB 11255 MedlinePlus 001273 eMedicine med/2001 MeSH D012078 Renal artery stenosis is the narrowing of the renal artery, most often caused by atherosclerosis or fibromuscular dysplasia. This narrowing of the renal artery can impede blood flow to the target kidney. Hypertension and atrophy of the affected kidney may result from renal artery stenosis, ultimately leading to renal failure if not treated. Contents 1 Signs and symptoms 2 Diagnosis 3 Etiology 4 Pathophysiology 5 Treatment 6 See also 7 References 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. Deterioration in renal function may develop if both kidneys are poorly supplied, or when treatment with an ACE inhibitor is initiated. Some patients present with episodes of flash pulmonary edema sudden left ventricular heart failure.1 Diagnosis refractory hypertension - high blood pressure that can not be controlled adequately with antihypertensives auscultation with stethoscope - bruit rushing sound on affected side, inferior of the costal margin captopril challenge test captopril test dose effect on the differential renal function as measured by MAG3 scan.2 renal artery arteriogram A clinical prediction rule is available to guide diagnosis.3 Etiology Atherosclerosis is the predominant cause of renal artery stenosis in the majority of patients, usually those with a sudden onset of hypertension at age 50 or older. Fibromuscular dysplasia is the predominant cause in young patients, usually females under 40 years of age. A variety of other causes exist. These include arteritis, renal artery aneurysm, extrinsic compression eg. neoplasms, neurofibromatosis, and fibrous bands. Pathophysiology The macula densa of the kidney senses a decreased systemic blood pressure due to the pressure drop over the stenosis. The response of the kidney to this decreased blood pressure is activation of the renin-angiotension aldosterone system, which normally counteracts low blood pressure, but in this case lead to hypertension high blood pressure. The decreased perfusion pressure caused by the stenosis leads to decreased blood flow hypoperfusion to the kidney and a decrease in the GFR. If the stenosis is long standing and severe the GFR in the affected kidneys never increases again and pre-renal renal failure is the result. Treatment When high-grade renal artery stenosis is documented and blood pressure cannot be controlled with medication, or if renal function deteriorates, renal artery stenosis is often treated invasively. Renal artery stenosis is most commonly treated by endovascular techniques i.e. angioplasty with or without stenting. A 2003 meta-analysis found that angioplasty was safe and effective in this context.4 There are ongoing clinical trials to compare medical management and angioplasty with stenting to medical management alone. These include CORAL and ASTRAL, both scheduled to report results in 2010. In addition to endovascular treatment, surgical resection and anastomosis is a rarely-used option. See also Renovascular hypertension References ^ Pickering TG, Herman L, Devereux RB, et al 1988. Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation. Lancet 2 8610: 551-2. doi:10.1016/S0140-67368892668-2. PMID 2900930. ^ Roccatello D, Picciotto G 1997. Captopril-enhanced scintigraphy using the method of the expected renogram: improved detection of patients with renin-dependent hypertension due to functionally significant renal artery stenosis PDF. Nephrol. Dial. Transplant. 12 10: 2081-6. doi:10.1093/ndt/12.10.2081. PMID 9351069. ^ Krijnen P, van Jaarsveld BC, Steyerberg EW, Man in 't Veld AJ, Schalekamp MA, Habbema JD 1998. A clinical prediction rule for renal artery stenosis. Ann. Intern. Med. 129 9: 705-11. PMID 9841602. ^ Nordmann AJ, Woo K, Parkes R, Logan AG 2003. Balloon angioplasty or medical therapy for hypertensive patients with atherosclerotic renal artery stenosis? A meta-analysis of randomized controlled trials. Am. J. Med. 114 1: 44-50. doi:10.1016/S0002-93430201396-7. PMID 12557864. v d e Cardiovascular disease: vascular disease - Circulatory system pathology I70-I99, 440-459 Arteries, arterioles and capillaries Arterial occlusive disease/ peripheral vascular disease Arteriosclerosis: Atherosclerosis - Intermittent claudication - Atheroma - Monckeberg's arteriosclerosis Stenosis Renal artery stenosis, Carotid artery stenosis - Fibromuscular dysplasia - Degos disease - Aortoiliac occlusive disease Raynaud's phenomenon/Raynaud's disease - Erythromelalgia Aneurysm Aortic aneurysm/Abdominal aortic aneurysm - Cerebral aneurysm - Coronary artery aneurysm - Intracranial berry aneurysm - Dissection Aortic, Carotid, Vertebral - Pseudoaneurysm Other Arteritis Aortitis - Buerger's disease Arteriovenous fistula - Herary hemorrhagic telangiectasia Nevus Spider angioma, Halo nevus, Cherry angioma Veins Venous thrombosis/ Phlebitis/ Thrombophlebitis primarily lower limb Deep vein thrombosis abdomen May-Thurner syndrome, Portal vein thrombosis, Budd-Chiari syndrome, Renal vein thrombosis upper limb/torso Paget-Schroetter disease, Mondor's disease head Cerebral venous sinus thrombosis Post-thrombotic syndrome Varicose veins Varicocele - Gastric varices - Portacaval anastomosis Hemorrhoid, Esophageal varices, Caput medusae Other Superior vena cava syndrome - Inferior vena cava syndrome - Venous ulcer Arteries or veins Vasculitis - Thrombosis - Embolism Pulmonary embolism, Cholesterol embolism - Angiopathy Macroangiopathy, Microangiopathy Lymphatic disease Lymphadenitis - Lymphedema - Lymphangitis Blood pressure Hypertension Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension Renovascular hypertension - Pulmonary hypertension Hypotension Orthostatic hypotension See also congenital, neoplasia v d e Urinary system - Pathology - Urologic disease N00-N39, 580-599 Abdominal Kidney/ nephropathy Glomerulus Nephritis/ glomerulonephritis by structure: Membranoproliferative glomerulonephritis - Membranous glomerulonephritis/Membranous nephritis - IgA nephropathy/glomerulonephritis by disease: Post-streptococcal glomerulonephritis - Lupus nephritis other: Rapidly progressive glomerulonephritis - Nephritic syndrome Nephrosis/ noninflammatory Glomerulosclerosis Focal segmental glomerulosclerosis, Diabetic nephropathy/glomerulosclerosis - Nephrotic syndrome Minimal change disease - Familial renal amyloidosis Tubulointerstitial/ Renal tubule Interstitial nephritis Pyelonephritis, Danubian endemic familial nephropathy Uropathy Obstructive uropathy, Hydronephrosis, Pyonephrosis Inborn errors of renal tubular transport Renal tubular acidosis, Gitelman syndrome Reflux nephropathy - Nephrogenic diabetes insipidus - Renal papillary necrosis Renal failure Acute renal failure Acute tubular necrosis - Chronic renal failure Other Renal osteodystrophy - Nephroptosis - Abderhalden-Kaufmann-Lignac syndrome vascular Renal artery stenosis, Hypertensive nephropathy, Renovascular hypertension Ureter Ureteritis - Ureterocele - Megaureter Pelvic Bladder Cystitis Interstitial cystitis, Trigonitis - Neurogenic bladder - Vesicointestinal fistula - Vesicoureteral reflux Urethra Urethritis Non-gonococcal urethritis - Urethral syndrome - Urethral stricture Other/general Urinary tract infection - Retroperitoneal fibrosis - Urolithiasis Kidney stone, Renal colic See also congenital, neoplasia, symptoms/signs Retrieved from http://en..org/wiki/Renal_artery_stenosis Categories: Kidney diseases Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Français Nederlands This page was last modified on 22 June 2008, at 16:4
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