RENAL ARTERY STENOSIS

RENAL ARTERY STENOSIS

  • Also known as Reno vascular hypertension
  • It is the narrowing of one or both of the renal arteries
ETIOLOGY:
  • most common cause - Atherosclerosis
  • fibromuscular dysplasia (FMD) - (young females)
  • Takayasu arteritis  - Asian population (pulseless disease)



CLINICAL FEATURE:

  • Refractory hypertension
  • sudden rise BP in preexisting HTN patient
  • flash pulmonary edema
  • presence of abdominal bruit (systole + diastole)
  • check peripheral pulses
  • poly arteritis nodosa - not cause of renal artery stenosis but can lead to Aneurysm formation



WORKUP:

  • USG - Asymmetric kidneys size
- Not responding to anti hypertensive medication

  • Doppler - best screening test
  • CT Angiography
  • Magnetic Resonant Angiography (MRA) - expensive
↓↓↓ 

- false positive results - due to turbulent flow
- Gadolinium - cause nephrogenic system fibrosis
  • IOC - Renal angiography (invasive test)(gold standard)
  • DTPA scan before and after giving ACE inhibitor (Captopril renogram)


TREATMENT:
  • ACE Inhibitors 
- Contraindicated in bilateral RAS because it causes efferent arteriole dilatation leading to loss of filtration gradient and increasing the risk of acute kidney injury
  • Calcium channel blockers
  • PTRA (percutaneous transluminal renal angioplasty)
↓↓↓
stenting
↓↓↓
preferred for - fibromuscular dysplasia

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