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What Is Renal Artery Stenosis?

Renal artery stenosis, also known as kidney stenosis, is a blockage of the kidney artery, which may ultimately lead to kidney failure and hypertension (high blood pressure). In most cases, the cause of renal artery stenosis is atherosclerosis, the build-up of cholesterol deposits (plaque) in the arteries. Other renal stenosis causes may also include conditions such as:

  • Fibromuscular dysplasia, which is abnormal cellular development in artery walls
  • Takayasu's arteritis, which is an inflammatory disease that affects the aorta and its branches, including the renal arteries

Advanced Diagnosis and Treatment for Patients with Renal Artery Disease

The Division of Vascular and Endovascular Surgery at Brigham and Women’s Hospital provides advanced diagnosis and treatment for patients with renal artery disease. State-of-the-art techniques, including minimally invasive (endovascular) treatment of renal artery stenosis, are available for patients. Part of the Heart & Vascular Center, Brigham and Women’s Hospital is an international referral site with broad experience managing vascular problems, ranging from the most common to the rare and complex. 24-hour consultation is available for urgent issues or emergencies.

Renal Artery Stenosis Information

What Causes Renal Artery Stenosis?

The renal artery plays a crucial part in helping the kidneys control blood pressure. Renal artery stenosis interferes with that function, commonly brought on by two main causes:

  1. Atherosclerosis of renal artery. Build-up of fats, cholesterol and plaque on the artery is the most common cause of kidney stenosis. As the build-up grows, it also hardens and restricts blood flow through the artery
  2. Fibromuscular dysplasia. A congenital disorder, occurring more commonly in women, that causes the artery wall muscle to grow abnormally, sometimes overthickening the artery wall and limiting blood flow

A variety of factors could put you at risk for developing renal artery stenosis; the most common are:

While these factors increase a person's risk, they do not necessarily cause stenosis of the renal artery. A patient with several of these risk factors may never develop the disease, while others with no known risk factors may develop it.

Symptoms of Renal Artery Stenosis

Renal artery stenosis symptoms don't often appear early and can be difficult to distinguish, even as the condition progresses. In some cases, a patient has no symptoms. Common symptoms of renal artery stenosis include:

  • 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 or worsening kidney function during treatment for high blood pressure
  • Sudden kidney failure upon first taking an angiotensin-converting enzyme (ACE) inhibitor medication
  • Recurrence of flash pulmonary edema (FPE), a build-up of fluid in the lungs
Renal Artery Stenosis Diagnosis

The Brigham and Women's Hospital's renal artery stenosis specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies, including:

While MRA and renal angiography are the two primary diagnosis tools for renal artery stenosis, other tools may also be used, such as blood and urine tests, ultrasounds or a computed tomography angiogram.

Renal Artery Stenosis Treatment

Renal artery stenosis treatment is personalized for each case and can include a combination of medication and surgery. If left untreated, renal artery stenosis grows progressively worse and can have a greater impact on kidney function. Specialists from the Brigham and Women’s Division of Vascular and Endovascular Surgery develop individualized treatment plans for renal artery stenosis patients based on:

  • Age
  • Overall health
  • Medical history
  • Severity and form of the disease
  • Tolerance for specific medications or procedures
  • Expectations for course of the disease
  • Presence of other conditions

Medication and Lifestyle Changes

Often the first options is to treat renal arterial stenosis medically and with lifestyle modifications.

Lifestyle changes may include:

  • Reducing weight
  • Quitting smoking
  • Increasing exercise
  • Modifying diet (low fat, low salt)

Medication options may include:

Procedures and Surgery

If determined that renal function is extremely impaired and medical treatment has failed to control hypertension, interventional or surgical treatment will be recommended. Those options include:

What to Expect at the Heart & Vascular Center

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from Brigham and Women’s main 75 Francis St. entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Watkins Clinic for pre-operative information and tests.

The day of your procedure, your care will be provided by physicians, anesthesiologists and nurses who specialize in surgery for patients with renal artery stenosis. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care from an experienced surgical and nursing staff.

During your procedure, family and friends can wait in the Shapiro Family Center. Staff members will provide surgery updates and caregivers who leave the hospital will be contacted by cell phone.

Multidisciplinary Care

Patients benefit from the teamwork of vascular and endovascular surgeons, medical cardiologists, interventional cardiologists, cardiovascular imaging experts and radiologists and anesthesiologists, all experts in peripheral artery disease, such as renal artery stenosis. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Additional Resources

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