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Renal artery stenosis
Terms in this set (11)
What is renal artery stenosis?
Stenosis of renal artery, resulting in decreased perfusion of the juxtaglomerular apparatus and subsequent activation of the renin-angiotensin-aldosterone system (i.e., hypertension from renal artery stenosis)
What is the incidence?
-10% to 15% of the U.S. population have HTN; of these, 4% have potentially correctable renovascular HTN
- Also note that 30% of malignant HTN have a renovascular etiology
What is the etiology of the stenosis?
66% result from atherosclerosis (men women), 33% result from fibromuscular dysplasia (women men, average age 40 years, and 50% with bilateral disease)
What is the classic profile of a patient with renal artery stenosis from fibromuscular dysplasia?
Young woman with hypertension
What are the associated risks/ clues?
Family history, early onset of HTN, HTN refractory to medical treatment
What are the signs/symptoms?
Most patients are asymptomatic but may have headache, diastolic HTN, flank bruits (present in 50%), and decreased renal function
What are the diagnostic tests?
A-gram Maps artery and extent of stenosis (gold standard)
IVP 80% of patients have delayed nephrogram phase (i.e., delayed filling of contrast)
Renal vein renin ratio (RVRR) If sampling of renal vein renin levels shows ratio between the two kidneys 1.5, then diagnostic for a unilateral stenosis
Captopril provocation test Will show a drop in BP
Are renin levels in serum ALWAYS elevated?
No: Systemic renin levels may also be measured but are only increased in malignant HTN, as the increased intravascular volume dilutes the elevated renin level in most patients
What is the invasive nonsurgical treatment?
Percutaneous Renal Transluminal Angioplasty (PRTA)/stenting: With FM dysplasia: use PRTA With atherosclerosis: use PRTA/stent
What is the surgical treatment?
Resection, bypass, vein/graft interposition, or endarterectomy
What antihypertensive medication is CONTRAINDICATED in patients with hypertension from renovascular stenosis?
ACE inhibitors (result in renal insufficiency)
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