Renal Artery Stenosis

  • Medical Author:
    Siamak N. Nabili, MD, MPH

    Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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What functional tests are used for the diagnosis of renal artery stenosis?

The main functional tests for renal artery stenosis include the plasma renin activity test and captopril renogram. These tests have been largely replaced by the imaging tests described above because they are less accurate, but they may be still performed to help establish the diagnosis of renal artery stenosis.

The plasma renin activity measures the activity of the hormone renin (described above). Activity of renin is generally higher in the kidney with renal artery stenosis compared to the other kidney. This response may be exaggerated by administration of captopril (Capoten), an ACE inhibitor medication used to treat high blood pressure.

The renogram measures the activity of the kidneys after injection of a radioactive material that is taken up by the kidney. By administering captopril prior to the test, the activity may become more enhanced on the normal kidney compared to the one with renal artery stenosis. This may indicate a significant renal artery narrowing on the side with less activity.

What are medical treatments for renal artery stenosis?

In bilateral (both-sided) and unilateral (one-sided) renal artery stenosis associated with high blood pressure, controlling the blood pressure with usual blood pressure medications is the first and the safest treatment. ACE inhibitors or ARB medications with or without a diuretic (water pill) may be tried first. This approach may lead in some patients to worsening of their kidney function. Therefore, kidney function needs to be followed closely and if worsening of kidney function is evident, these medications may need to be stopped.

It is worth noting that if renal artery stenosis is found incidentally when performing a test for another disease and there is no evidence of kidney dysfunction or high blood pressure, then no treatment may be necessary. Sometimes even significant stenosis may not be associated with high blood pressure or kidney dysfunction. In these situations, periodic monitoring of blood pressure and kidney function may be advised.

Medically Reviewed by a Doctor on 6/4/2015

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