Renal Artery Stenosis
- Must Be Recognised Before Aortic Reconstruction Surgery And Corrected If
Possible
- Clamping aorta near renal arteries can precipitate acute renal failure
- Surgical reconstruction can be performed at the same time as aneurysm
repair
Presentation
- ↑ BP (Activation of renin-angiotensin system)
- Functional Renal Impairment
- e.g. Chronic Renal Failure, Acute Renal Failure (often precipitated by ACE
inhibitor) or
- Incidental finding on Urography, angiogram (aortic, coronary), USS (when
small kidney noticed)
- Renal artery bruit on Abdominal
Examination
Pathology
- Fibromuscular Hyperplasia
- In Children and young adults
- Middle to distal part of artery
- Responds well to balloon dilatation often leading to ↓ BP
- Atherosclerosis
- Older patients
- Usually involves origin of artery - e.g.
- May be treatable by balloon dilatation
- Effect on BP unpredictable
Treatment
- Balloon dilatation
- Venous graft
- Stent
- Nephrectomy (as treatment for hypertension)
|