What is it?
It is a stenosing lesion affecting the main renal artery or its segmental vessels. In most cases, it is determined by the presence of an atherosclerotic plaque, and in a reduced percentage, it has fibrodysplastic origin. Stenosis results in reduced renal perfusion, which can lead to both hypertension and worsened renal function in cases where it affects the renal artery. As renal atherosclerotic disease is continuously increasing, especially in the elderly population, it is important to implement a preventive analysis to identify patients with potential renal stenotic lesions.
Causes and risk factors
The risk elements are as follows:
- hypertension that is difficult to control;
- renal insufficiency especially in the absence of urinary changes;
- worsening of renal function after ACE-inhibitor therapy and hypokalemia with elevated potassiuria.
Which are the symptoms?
Manifestations depend on the rate of onset (acute or chronic), extent, one-sided or two-sided, and duration of renal hypoperfusion. Renal artery stenosis is usually asymptomatic for a considerable period of time.
- Constant and severe flank pain
- Abdominal pain
- Arterial Hypertension
How is it diagnosed?
The diagnosis is suspected in patients with renal insufficiency who have acute occlusion systomas of the renal artery, systomas or signs of thromboembolism, hypertension with onset before the age of 30 years or refractory to treatment with more than 3 antihypertensive drugs. Patient identified as possibly having renal artery stenosis undergoes blood and urine testing to confirm renal failure. The diagnosis is confirmed by imaging tests.
How is it treated?
For several years, the treatment of stenotic lesions by percutaneous angioplasty (PTA) has been considered the revascularization procedure of first choice, reserving the use of conventional surgery (aorto-renal bypass) only in cases where percutaneous treatment has proved ineffective. Restoration of renal blood flow after dilatation treatment or endovascular stent placement may produce an improvement in pressor control and renal function and in some cases may lead to discontinuation of antihypertensive therapy.
In the presence of a hemodynamically significant stenosing lesion, a short hospitalization is proposed for the performance of transluminal angioplasty (PTRA) or endovascular stent placement.
After discharge, the patient is followed up at a specific outpatient clinic where blood pressure and renal function are checked.
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