Renal artery stenosis

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Última revisão: 18 Aug 2025

Última atualização: 06 Jan 2023

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 edema are common features.

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

Definitive diagnosis is with imaging.

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

Definição

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] Ischemic 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.

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

dyslipidemia
smoking
diabetes
female sex

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

serum creatinine
serum potassium
urinalysis and sediment evaluation
aldosterone-to-renin ratio

Detalhes completos

Investigações a serem consideradas

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

Detalhes completos

Algoritmo de tratamento

CONTÍNUA

atherosclerotic RAS

fibromuscular dysplasia

Colaboradores

Autores

Mauricio Leitao, MD, MBA

Clinical Research Coordinator

University of Massachusetts Chan Medical School

UMass Memorial Medical Center

Worcester

Declarações

ML declares that he has no competing interests.

Alvaro Alonso, MD, MSCR, FSVM

Associate Professor of Medicine

University of Massachusetts Chan Medical School

UMass Memorial Medical Center

Worcester

Declarações

AA declares that he has no competing interests.

Agradecimentos

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

Revisores

Robert Tompkins, MD

Associate Professor

Department of Family Medicine

University of Texas Health Science Center

Tyler

Declarações

RT declares that he has no competing interests.

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

Declarações

IM declares that he has no competing interests.

John Webster, MD

Professor

Aberdeen Royal Infirmary

Foresterhill

Scotland

Declarações

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

Declarações

NAK declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Parikh SA, Shishehbor MH, Gray BH, et al. SCAI expert consensus statement for renal artery stenting appropriate use. Catheter Cardiovasc Interv. 2014 Dec 1;84(7):1163-71.Texto completo Resumo

Gornik HL, Persu A, Adlam D, et al. First International Consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med. 2019 Jan 16;24(2):164-89.Texto completo Resumo

Anderson JL, Halperin JL, Albert NM, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Apr 2;127(13):1425-43.Texto completo Resumo

Aboyans V, Ricco JB, Bartelink ME, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018 Mar 1;39(9):763-816.Texto completo Resumo

American College of Radiology. ACR appropriateness criteria: renovascular hypertension. 2017 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Essential hypertension
- Acute kidney injury
- Renal artery dissection
Mais Diagnósticos diferenciais
Diretrizes
- 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
Mais Diretrizes
Folhetos informativos para os pacientes
High blood pressure
High cholesterol
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Renal artery stenosis

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

atherosclerotic RAS

fibromuscular dysplasia

Colaboradores

Autores

Mauricio Leitao, MD, MBA

Declarações

Alvaro Alonso, MD, MSCR, FSVM

Declarações

Agradecimentos

Revisores

Robert Tompkins, MD

Declarações

Irfan Moinuddin, MD

Declarações

John Webster, MD

Declarações

Neil A. Kurtzman, MD

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice