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Renal Vascular Disease

Renal vascular disease refers to various problems that affect the arteries and veins of the kidneys. Renal artery stenosis (RAS) is the narrowing of the lining of the main artery that supplies the kidneys. When your kidneys' blood flow is normal, they filter waste from your body into your urine. Your kidneys also help control your blood pressure by sensing the blood pressure and secreting a hormone, called renin, into your bloodstream.

When your kidneys' blood flow is blocked, your kidneys cannot effectively remove waste from your body. A blockage or narrowing of the arteries can also affect the amount of renin secreted by your kidneys, which helps regulate your blood pressure. Renal vascular disease is often associated with hypertension (high blood pressure). Uncontrolled renal vascular disease can damage the tissues of the kidneys and cause kidney failure and/or high blood pressure.

Anatomy of the kidney graphic

Renal vascular disease symptoms

Renal vascular disease usually goes undetected and is hard to detect during a normal checkup. Hypertension, or high blood pressure, is the most common symptom. Renovascular conditions develop slowly and worsen over time. If you have high blood pressure, the first sign you may have renal artery stenosis is your high blood pressure may become worse or the medications you take to control your high blood pressure may not be effective. Other signs that you have renal vascular disease include:

  • Pain in the sides of your abdomen, legs or thighs
  • Blood in your urine
  • Protein in your urine
  • An enlarged kidney that your physician can feel
  • Fever, nausea or vomiting
  • High blood pressure
  • Sudden, severe swelling in your leg
  • Difficulty breathing

Renal vascular disease causes

The main causes include:

  • Atherosclerosis
  • Injury
  • Infection
  • Inflammation or other underlying disease
  • Surgery
  • Tumor
  • Aneurysm
  • Pregnancy
  • Certain medicines
  • Birth defect

Renal vascular disease tests

Renal vascular disease is commonly detected using the following:

  • Ultrasound
  • Angiography
  • CT scan
  • MRA
  • Doppler ultrasound

Renal vascular disease treatments

  • Medication, such as antihypertensive drugs, may be used to control high blood pressure. If your physician diagnoses renal artery stenosis, he or she may prescribe blood pressure medications. These medications may include diuretics, ACE inhibitors (a drug to reduce your blood pressure), beta blockers, calcium channel blockers and angiotensin receptor blockers (ARBs).
  • Angioplasty and stenting may be used to improve the circulation of blood flow to the kidney and prevent the release of excess renin, which can help to decrease blood pressure.
  • Surgery to bypass the narrowing may be performed.
  • Renal endarterectomy, bypass, angioplasty and stents

Renal vascular disease refers to a variety of complications that affect the arteries and veins of the kidneys. These complications affect blood circulation of the kidneys, and may damage kidney tissue and cause kidney failure and/or high blood pressure. We use a number of procedures to treat renal vascular disease:

  • Angioplasty and stents
    During this minimally invasive procedure, a catheter with a balloon attached to the end is inserted through the renal artery. Once the catheter reaches the blockage or narrowing, the balloon is inflated to widen the artery. Sometimes, a stent is inserted to the point of blockage. Once positioned, it is expanded to keep the artery wall from re-narrowing.

  • Bypass
    A renal bypass is a surgical procedure that bypasses the occluded renal artery. There are several variations of such procedures.

  • Endarterectomy
    In a renal endarterectomy, your surgeon removes the plaque from the inner lining of your renal artery. The artery is then widened, returning blood flow to normal.

These procedures are for symptomatic renal vascular disease only. They are needed when there is a severe narrowing along with an elevation in creatinine (found during a blood test that helps assess kidney function) and/or uncontrolled high blood pressure that requires multiple medications to treat.

Learn about hemodialysis access for chronic renal failure.

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