Renal vascular disease

What is it?

It is a stenotic lesion affecting the main renal artery or its segmental vessels. In most cases it is caused by an atherosclerotic plaque, and in a small percentage of cases it has a fibrodysplastic origin.

Stenosis leads to reduced renal perfusion, which in turn can cause hypertension and impaired renal function, if it affects the renal artery in case of one functioning kidney, or if it affects the renal arteries bilaterally.

Causes and risk factors

As atherosclerotic kidney disease is progressing, it is essential, especially in the elderly population, to carry out prophylactic analysis to identify patients with potential renal artery stenosis. The risk elements are:

  • polivasculopathy;
  • uncontrolled hypertension
  • diabetes;
  • renal failure, especially with no changes in the urine;
  • deterioration of renal function after ACE-inhibitors and hypokalaemia with increased urine potassium.

How is it diagnosed?

Suggested exams

How is it treated?

For several years, treatment of stenotic lesions with percutaneous angioplasty (PTA) has been considered the first choice procedure for revascularisation, and traditional surgery (aorto-renal bypass) has only been used when percutaneous treatment had failed. Restoration of renal blood flow after dilatation treatment or endovascular stent placement may lead to improved control of blood pressure and renal function, and in some cases may lead to discontinuation of antihypertensive therapy.

A patient identified as a possible carrier of renal artery stenosis undergoes a renal artery Doppler echocardiography and, for diagnostic confirmation, a renal artery angioresonance.

In case of a haemodynamically significant stenotic lesion, a short hospital admission for transluminal angioplasty (PTRA) or endovascular stent placement is suggested.

After discharge, the patient is followed up at a special outpatient clinic where blood pressure and kidney function are checked.

Suggested procedures

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