Renal artery stenosis
Overview
Renal artery stenosis is the narrowing of the renal artery, most often caused by atherosclerosis or fibromuscular dysplasia. This narrowing of the renal artery can impede blood flow of the target kidney. Hypertension and atrophy of the affected kidney may result from renal artery stenosis, ultimately leading to renal failure if not treated.
Symptoms
Mst cases f renal artery stensis are asymptmatic, and the main prblem is high bld pressure that cannt be cntrlled with medicatin. Deteriratin in renal functin may develp if bth kidneys are prly supplied, r when treatment with an ACE inhibitr is initiated. Sme patients present with episdes f flash pulmnary edema (sudden left ventricular heart failure)
Diagnosis
refractry hypertensin - high bld pressure that can nt be cntrlled adequately with antihypertensives auscultatin (with stethscpe) - bruit ("rushing" sund) n affected side, inferir f the cstal margin captpril challenge test captpril test dse effect n the differential renal functin as measured by MAG3 scan.[2] renal artery arterigram
Treatment
When high-grade renal artery stensis is dcumented and bld pressure cannt be cntrlled with medicatin, r if renal functin deterirates, renal artery stensis is ften treated invasively. Renal artery stensis is mst cmmnly treated by endvascular techniques (i.e. angiplasty with r withut stenting). A 2003 meta-analysis fund that angiplasty was safe and effective in this cntext.[4] There are nging clinical trials tcmpare medical management and angiplasty with stenting tmedical management alne. These include CRAL and ASTRAL, bth scheduled treprt results in 2010. In additin tendvascular treatment, surgical resectin and anastmsis is a rarely-used ptin.