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Renal Artery Stenosis

Title               

Ñ    Renal Artery Stenosis

Definition

Ñ    Narrowing of renal arteries

Pathogenesis

Causes

Ñ    Fibromuscular dysplasia

Ñ    Atheroma

Pathophysiology

Ñ    Reduced renal perfusion causes stimulation of the juxtaglomerular apparatus

This will result in:

Ñ    Increased renin, angiotensin and aldosterone levels

Clinical Features

History

Ñ    Young women:

Fibromuscular dysplasia

Ñ    Older age group, arteriopath:

Atheroma

Examination

CVS

Ñ    Hypertension

KUS

Ñ    Bruit over renal artery

Investigations

Fluids

Urine

Ñ    Proteinuria:

Feature of renovascular disease

Imaging

Abdominal Ultrasound

Ñ    Unequal length in unilateral stenosis:

> 1.5 cms difference

Intravenous urography

Ñ    Delayed nephrogram

Ñ    Unequal size

Ñ    Increased density of pyelogram phase:

Increased reabsorption in ischaemic kidney

CT scan

Ñ    Non-invasive imaging of renal arteries

MRI

Ñ    Visualise renal arteries

Renal arteriography

Ñ    Gold standard

Ñ    Allows intervention

Nuclear Medicine

Radionuclide studies with ACE inhibitors             

Ñ    Decreased uptake

Management

Control

Drugs

Ñ    Avoid ACE inhibitors

Surgery

Ñ    Angioplasty

Ñ    Stent

Ñ    Reconstructive vascular surgery

Ñ    Nephrectomy

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