Renal artery stenosis

Last reviewed: 1 Nov 2022
Last updated: 14 Aug 2019

Summary

Definition

History and exam

Key diagnostic factors

  • onset of hypertension age >55 years
  • history of accelerated, malignant, or resistant hypertension
  • history of unexplained kidney dysfunction
  • history of multivessel coronary artery disease
  • history of other peripheral vascular disease
  • abdominal bruit
  • sudden or unexplained recurrent pulmonary edema
  • onset of hypertension age <30 years
More key diagnostic factors

Other diagnostic factors

  • absence of family history of hypertension
  • other bruits
  • history of acute kidney injury after administration of ACE inhibitor or angiotensin II receptor antagonist
  • history of unexplained congestive heart failure
  • refractory angina
  • history of hypokalemia
Other diagnostic factors

Risk factors

  • dyslipidemia
  • smoking
  • diabetes
  • female sex
More risk factors

Diagnostic investigations

1st investigations to order

  • serum creatinine
  • serum potassium
  • urinalysis and sediment evaluation
  • aldosterone-to-renin ratio
More 1st investigations to order

Investigations to consider

  • duplex ultrasound
  • gadolinium-enhanced MR angiography (MRA)
  • CT angiography
  • conventional angiography
  • carbon dioxide (CO2) angiography
  • noncontrast magnetic resonance angiography
  • captopril radionuclide renal scan
More investigations to consider

Treatment algorithm

ONGOING

atherosclerotic RAS

fibromuscular dysplasia

Contributors

Authors

Rohit Malhotra, MBBS

Interventional Cardiology Fellow

Mount Sinai Hospital

New York

NY

Disclosures

RM declares that he has no competing interests.

Alvaro Alonso, MD, FSVM

Assistant Professor of Medicine

University of Massachusetts Medical School

UMass Memorial Medical Center

Worcester

MA

Disclosures

AA declares that he has no competing interests.

Acknowledgements

RM and AA would like to gratefully acknowledge Dr Manmeet Singh and Dr Scott J. Gilbert, previous contributors to this topic. MS and SJG declare that they have no competing interests.

Peer reviewers

Robert Tompkins, MD

Associate Professor

Department of Family Medicine

University of Texas Health Science Center

Tyler

TX

Disclosures

RT declares that he has no competing interests.

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

IL

Disclosures

IM declares that he has no competing interests.

John Webster, MD

Professor

Aberdeen Royal Infirmary

Foresterhill

Scotland

Disclosures

JW declares that he has no competing interests.

Neil A. Kurtzman, MD

Grover E. Murray Professor

University Distinguished Professor

Texas Tech University Medical Center

Lubbock

TX

Disclosures

NAK declares that he has no competing interests.

  • Renal artery stenosis images
  • Differentials

    • Essential hypertension
    • Acute kidney injury
    • Renal artery dissection
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  • Guidelines

    • 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS)
    • 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
    More Guidelines
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