Renal artery stenosis

Renal artery stenosis (RAS) is typically due to atherosclerotic disease or fibromuscular dysplasia.

RAS often presents with accelerated or difficult-to-control hypertension.

Worsening kidney function, especially after initiating renin-angiotensin blockade, and recurrent flash pulmonary oedema are common features.

Presence of renal artery narrowing does not necessarily indicate clinical consequences. Renal artery stenosis, renovascular hypertension, and ischaemic nephropathy are various manifestations of this process.

Definitive diagnosis is with imaging.

Management typically involves medical therapy, with revascularisation reserved for selected high-risk or severe cases.

RAS is a narrowing of the renal artery lumen. It is considered angiographically significant if more than a 50% reduction in vessel diameter is present.[1]Safian RD, Textor SC. Renal-artery stenosis. N Engl J Med. 2001 Feb 8;344(6):431-42. http://www.ncbi.nlm.nih.gov/pubmed/11172181?tool=bestpractice.com Ischaemic nephropathy is a chronic reduction in glomerular filtration rate that occurs from a narrowing in the renal artery. Renovascular hypertension is hypertension mediated by high levels of renin and angiotensin II, produced by an underperfused kidney supplied by a stenosed renal artery.