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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. 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.

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Medical Editor:

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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In this Article

• What are the renal arteries?
• What is renal artery stenosis?
• What are the causes of renal artery stenosis?
• How common is renal artery stenosis?
• What are the symptoms of renal artery stenosis?
• What problems does renal artery stenosis cause?
• Who should be screened for renal artery stenosis?
• How is renal artery stenosis diagnosed?
• What are the common imaging tests to evaluate renal artery stenosis?
• What functional tests are used for the diagnosis of renal artery stenosis?
• What are medical treatments for renal artery stenosis?
• What surgical procedures are available for renal artery stenosis?
• Which patients can benefit from surgical procedures for renal artery stenosis?
• Renal Artery Stenosis At A Glance
• Patient Comments: Renal Artery Stenosis - Cause
• Patient Comments: Renal Artery Stenosis - Diagnosis
• Find a local Nephrologist in your town
• Renal Artery Stenosis Index

In patients with renal failure due to bilateral renal artery stenosis (narrowing on both kidneys), angioplasty procedures for both renal arteries may improve or stabilize kidney function. Similarly, in hypertensive patients with unilateral (one-sided) renal artery stenosis, angioplasty procedures of the involved renal artery may cure or improve the high blood pressure. Patients with milder degrees of stenosis (less than a 75% reduction in the width of the renal artery lumen) usually do not benefit from angioplasty. These patients need to be followed by sequential imaging procedures to detect further narrowing (progression) to the point of treatable stenosis. At that point, angioplasty procedures can be done with the hope of a favorable response.

Some studies have suggested that patients with a very high degree of renal vascular resistance (which reflects permanent damage to the kidneys), even with a 75% or more stenosis of the renal artery, often have a poor response to the angioplasty procedures. (The tension of the blood vessels to the kidney, called renal vascular resistance, is measured by Doppler ultrasonography. A so-called resistive index over 0.8 is considered very high). In these patients, angioplasty is usually not done and the high blood pressure or renal failure is managed only by the customary therapeutic measures for these problems as described previously.

• Elevated blood pressure (hypertension) is common and is generally simply treated with medications.
  
  
• Likewise, various other methods are used to treat the large majority of patients with kidney failure.
  
  
• There is a small subgroup of patients with high blood pressure or renal failure caused by renal artery stenosis.
  
  
• Some of these patients may respond favorably to dilating the narrowed artery, using the technique of angioplasty.
  
  
• The patients that can benefit from angioplasty have a severe stenosis (75 % or greater narrowing) of the renal artery and do not have a very high renal vascular resistance.

References:

eMedicine, "Renal Artery Stenosis."

eMedicine, "Renal Artery Stenosis/Renovascular Hypertension."

Previous contributing author and editor: Dwight Makoff, M.D. and Leslie J. Schoenfield, M.D., Ph.D.