What is Renovascular Disease?

Renovascular Disease refers to conditions that affect the blood vessels supplying the kidneys, primarily involving narrowing (stenosis) or blockage of the renal arteries. This impairs blood flow to the kidneys, potentially leading to high blood pressure (renovascular hypertension) and kidney damage.

What Causes Renovascular Disease?

Common causes include:

• Atherosclerosis (hardening and narrowing of arteries due to plaque buildup), the most frequent cause in older adults
• Fibromuscular dysplasia, a non-atherosclerotic, non-inflammatory condition causing arterial narrowing, more common in younger women
• Blood clots or emboli blocking the renal arteries
• Vasculitis (inflammation of blood vessels) affecting the renal arteries
• Rare causes such as trauma or external compression

What Are the Symptoms of Renovascular Disease?

Symptoms can be variable and may include:

• High blood pressure that is difficult to control with medications
• Sudden onset or worsening of hypertension
• Decreased kidney function or unexplained kidney failure
• Flash pulmonary edema (sudden fluid buildup in lungs) in severe cases
• Abdominal or flank pain (less common)

How Is Renovascular Disease Diagnosed?

Diagnosis involves a combination of clinical assessment and imaging tests:

• Blood pressure measurement and monitoring for resistant hypertension
• Blood tests to evaluate kidney function
• Doppler ultrasound to assess renal artery blood flow
• CT angiography (CTA) or MR angiography (MRA) for detailed images of renal arteries
• Renal artery angiography, an invasive test considered the gold standard, sometimes combined with intervention

What Are the Treatment Options for Renovascular Disease?

Treatment depends on the cause and severity:

• Medications to control blood pressure and protect kidney function (ACE inhibitors, ARBs, diuretics)
• Lifestyle modifications including diet, exercise, and smoking cessation
• Percutaneous transluminal renal angioplasty (PTRA) with or without stenting to open narrowed arteries
• Surgical revascularization in select cases
• Managing underlying conditions like atherosclerosis or vasculitis

Can Renovascular Disease Cause Complications?

Complications may include:

• Chronic kidney disease or progression to kidney failure
• Uncontrolled hypertension leading to heart disease, stroke, or other vascular complications
• Pulmonary edema due to fluid overload
• Recurrent episodes of acute kidney injury