Renal artery stenosis

What is it?

It is a stenotic lesion affecting the main renal artery or its segmental vessels. In most cases, it is caused by the presence of atherosclerotic plaque, and in a small percentage of cases, it has a fibrodysplastic origin. Stenosis leads to reduced renal perfusion, which can lead to both hypertension and impaired renal function if it affects the renal artery in the presence of a single functioning kidney or if it affects the renal arteries bilaterally.

Which are the symptoms?

As atherosclerotic renal disease is increasing, especially in the elderly population, it is important to carry out prophylactic analysis to identify patients with potential stenotic renal lesions. Risk factors that may raise diagnostic suspicion are the presence of polyvasculopathy, hypertension that is difficult to control, diabetes, renal failure, especially in the absence of urinary changes, worsening of renal function after Ace-inhibitor therapy and hypokalemia with increased potassium.

·         arterial hypertonia

·         edema

·         heart failure

·         impaired renal function

How is it diagnosed?

A patient identified as a possible carrier of renal artery stenosis undergoes diagnostic tests, primarily renal artery echocordopleurography, and renal artery angioresonance may be used for further diagnostic confirmation.

Suggested exams

How is it treated?

For several years, treatment of stenotic lesions with percutaneous angioplasty (PTA) has been considered to be the procedure of first choice for revascularisation and traditional surgery (aorto-renal bypass) has only been used when percutaneous treatment has not been effective. Restoration of renal blood flow after dilatational treatment or endovascular stent placement can lead to improved control of blood pressure and renal function, and in some cases may lead to discontinuation of antihypertensive therapy. A short hospital admission for transluminal angioplasty (PTRA) or endovascular stent placement is suggested in the presence of a haemodynamically significant stenotic lesion. After hospital discharge, the patient is monitored in a special outpatient clinic, where blood pressure and renal function are checked.

Suggested procedures

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