Renal Artery Stenosis

Renal artery stenosis is a blockage of an artery to the kidneys, which may ultimately lead to kidney failure and hypertension (high blood pressure). In most cases, this blockage is caused by atherosclerosis, the build-up of cholesterol deposits (plaque) in arteries, but may also be caused by conditions such as fibromuscular dysplasia, abnormal cellular development in artery walls, and Takayasu's arteritis, an inflammatory disease that affects the aorta and its branches, including the renal arteries.

What are the risk factors for renal artery stenosis?

There are a variety of factors that could put you at risk for developing renal artery stenosis. Here is a list of the most common risk factors:

• advanced age
• female
• atherosclerosis
• hypertension, particularly new onset of hypertension in an older person
• smoking
• high cholesterol
• diabetes

Keep in mind that although these factors increase a person's risk, they do not necessarily cause the disease. Someone with several of the risk factors noted above may never develop the disease, while someone else with no known risk factors may develop the disease.

What are the symptoms of renal artery stenosis?

Here are some common signs that you may have developed renal artery stenosis:

• sudden onset of hypertension
• hypertension not responsive to three or more blood pressure medications
• increased urea (waste product excreted by the kidneys) in the blood
• unexplained kidney failure
• sudden kidney failure upon first taking an angiotensin-converting enzyme (ACE) inhibitor medication
• reoccurrence of flash pulmonary edema (FPE), a build-up of fluid in the lungs

How is renal artery stenosis diagnosed?

Any patient with impaired renal function and severe hypertension should be evaluated by a physician as soon as possible. BWH can perform a variety of minimally invasive and non-invasive diagnostic tests, such as:

• magnetic resonance angiography (MRA) – a non-invasive imaging procedure that uses MRI technology to evaluate the condition of the renal arteries
• coronary angiography – a minimally invasive procedure whereby a small catheter is used to enable an X-ray examination of the renal arteries

How is renal artery stenosis treated?

If it is determined that renal function is extremely impaired and intervention has failed to control hypertension, treatment will be recommended. Most cases can be treated with a minimally invasive renal artery angioplasty, using either a balloon to open up the artery or a stent to keep the artery open. In rare severe cases, avascular surgeon will perform one of the following open procedures: an endarterectomy, the surgical removal of plaque, or a bypass, which creates a detour around the blocked portion of your artery.

How can I learn more?

Patients seeking information should contact the Division of Vascular and Endovascular Surgery at 857-307-1920.