Renal Artery Disease

Renal artery disease affects the main blood supply of the kidneys (the renal artery). Also called renal artery stenosis, it is a narrowing or blockage of the artery that supplies the kidney.

The most common cause is atherosclerosis, or “hardening” of the arteries. Atherosclerotic renal artery stenosis is usually seen in older individuals who may have vascular disease in other areas as well (such as the heart or legs). 

Renal artery stenosis may also be caused by  medial fibroplasia ,also called fibromuscular dysplasia.  This is seen in younger patients (commonly, females in their third or fourth decade of life) and is due to abnormal development of the artery wall.

Renal artery disease is one of the causes of hypertension. Although it is a much less common cause than primary (no underlying cause) hypertension, it is important to recognize, since treatment of the renal artery stenosis can improve or even cure the hypertension. In other cases, renal artery stenosis may cause poor kidney function, and correction of the narrowing may improve kidney function.

Symptoms

• Hypertension that was previously well-controlled but then becomes difficult to control
• Need for three or more medications to control hypertension
• Episodes of heart failure
• Renal insufficiency noted on a blood test

Diagnostic Tests

Many tests are used to diagnose renal artery stenosis. The first and most important is a well-performed history and physical examination. This usually provides clues that renal artery stenosis may be present. If suspected, additional tests may be ordered. These tests may include:

• Physical examination and patient history 
• Radionuclide scanning
• Renal artery Duplex  ultrasound
• Renal arteriography
• Magnetic Resonance Imaging (MR)
• Computed Tomography (CT) scan

• Medical treatment
• Balloon angioplasty and stenting
• Surgical Bypass or Endarterectomy