Renal artery stenosis
From Wikipedia, the free encyclopedia
| ICD-9 | 440.1 |
|---|---|
| MedlinePlus | 001273 |
| eMedicine | med/2001 |
Renal artery stenosis is the narrowing of the renal artery. It is caused by atherosclerosis or fibromuscular dysplasia. This can lead to atrophy of the affected kidney. It can lead to renal failure, if not treated. It is often unmasked by the rapid worsening of renal function in response to the administration of a drug from the ACE inhibitor class.
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[edit] 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
- renal artery arteriogram
[edit] Etiology
Atherosclerosis is the predominant cause 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 aneurysms, extrinsic compression (eg. neoplasms), neurofibromatosis and fibrous bands.
[edit] Differential diagnosis
[edit] 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.
[edit] Treatment
Treatment of renal artery stenosis may be necessary if the blood pressure cannot be controlled medically, or the renal function deteriorates. Nordmann et al (2003) found that angioplasty with stenting was safe and effective in this context. Surgical resection and anastomosis is a rarely-used option.
[edit] See also
[edit] Reference
- Nordmann AJ, Woo K, Parkes R, Logan AG. Balloon angioplasty or medical therapy for hypertensive patients with atherosclerotic renal artery stenosis? A meta-analysis of randomized controlled trials. Am J Med 2003;114:44-50. PMID 12557864.
[edit] External links
- Renal Artery Stenosis - emedicine.com
Diseases of the glomerulus: Lupus nephritis | Post-infectious glomerulonephritis | Minimal change disease | Focal segmental glomerulosclerosis | Diabetic nephropathy | IgA nephropathy
Diseases of the proximal convoluted tubules: Fanconi syndrome (Type II renal tubular acidosis) | renal cell carcinoma
Diseases of the distal convoluted tubules: pseudohypoaldosteronism (Type IV renal tubular acidosis)
Diseases of the collecting duct: Type I renal tubular acidosis
Tumours of the kidney: renal cell carcinoma | Wilms' tumour (children)
Diseases of the renal vasculature: renal artery stenosis | vasculitis | atheroembolic disease
Tubulointerstitial diseases of the kidney: Drug-induced interstitial nephritis | Obstructive nephropathy | Radiation nephritis | Reflux nephropathy | Sarcoidosis
Genetic diseases of the kidney/syndromes associated with kidney dysfunction: Alport syndrome | Polycystic kidney disease | Wilms' tumour (children) | von Hippel-Lindau syndrome | Hereditary papillary renal carcinoma | Birt-Hogg-Dube syndrome | Hereditary renal carcinoma
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