Renal artery stenosis: Difference between revisions
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[[image:fibromusculardysplasia.jpg|right|thumb|300px|In this angiography, you can see a "string of beads" appearance to the renal artery, the classic sign of '''fibromuscular dysplasia'''.]] | [[image:fibromusculardysplasia.jpg|right|thumb|300px|In this angiography, you can see a "string of beads" appearance to the renal artery, the classic sign of '''fibromuscular dysplasia'''.]] | ||
==Definition== | ===Definition=== | ||
Where a narrowing of the renal artery causes problems. | Where a narrowing of the renal artery causes problems. | ||
==Epidemiology== | ===Epidemiology=== | ||
[[image:common.jpg|left]] Pretty common, generally seen around the age of 50. | [[image:common.jpg|left]] Pretty common, generally seen around the age of 50. | ||
==Pathophysiology== | ===Pathophysiology=== | ||
The artery supplying the [[kidneys]] gets smaller. Usually this is due to '''[[atherosclerosis]]''', where cholesterol deposits in the artery cause a narrowing. | The artery supplying the [[kidneys]] gets smaller. Usually this is due to '''[[atherosclerosis]]''', where cholesterol deposits in the artery cause a narrowing. | ||
It can be down to '''fibromuscular dysplasia''' in young females - if so it will cause a "beaded" appearance of the renal artery on angiography. | It can be down to '''fibromuscular dysplasia''' in young females - if so it will cause a "beaded" appearance of the renal artery on angiography. | ||
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==Clinical Features== | ===Clinical Features=== | ||
Classically, they are generally asymptomatic, with a patient just suffering from [[secondary hypertension]], that isn't easily controlled with medication. | Classically, they are generally asymptomatic, with a patient just suffering from [[secondary hypertension]], that isn't easily controlled with medication. | ||
==Investigations== | ===Investigations=== | ||
==Management== | Angiography can often show a narrowing of the blood vessel, or the beaded appearance of fibromuscular dysplasia. | ||
===Management=== | |||
As said before, it can be hard to treat clinically. Often, patients will be started on an [[ACE inhibitor]] since the doctor assumes its [[essential hypertension]]. This can cause a deterioration in renal function, so '''ACE inhibitors should not be given with renal artery stenosis'''. | |||
The best management is to try to prevent further atherosclerosis, adjusting risk factors such as [[cholesterol]] and [[smoking]] using [[Prevention_of_ischaemic_heart_disease|standard prevention treatments]]. | |||
If renal function deteriorates, blood pressure can't be controlled, or the cause is fibromuscular dysplasia, the treatment is angioplasty (surgical vessel widening), with or without stenting. | |||
Revision as of 14:29, 23 May 2010
Definition
Where a narrowing of the renal artery causes problems.
Epidemiology
Pretty common, generally seen around the age of 50.
Pathophysiology
The artery supplying the kidneys gets smaller. Usually this is due to atherosclerosis, where cholesterol deposits in the artery cause a narrowing.
It can be down to fibromuscular dysplasia in young females - if so it will cause a "beaded" appearance of the renal artery on angiography.
Clinical Features
Classically, they are generally asymptomatic, with a patient just suffering from secondary hypertension, that isn't easily controlled with medication.
Investigations
Angiography can often show a narrowing of the blood vessel, or the beaded appearance of fibromuscular dysplasia.
Management
As said before, it can be hard to treat clinically. Often, patients will be started on an ACE inhibitor since the doctor assumes its essential hypertension. This can cause a deterioration in renal function, so ACE inhibitors should not be given with renal artery stenosis.
The best management is to try to prevent further atherosclerosis, adjusting risk factors such as cholesterol and smoking using standard prevention treatments.
If renal function deteriorates, blood pressure can't be controlled, or the cause is fibromuscular dysplasia, the treatment is angioplasty (surgical vessel widening), with or without stenting.