What is Renovascular Disease?

Male Urinary Tract
Male urinary tract
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Female Urinary Tract
Female urinary tract
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Renovascular Kidney
Renovascular Kidney
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

Most kidneys work well to clean the blood and keep the body's fluids and electrolytes in balance. But sometimes, the arteries of the kidneys can get smaller or become blocked. This can seriously damage this important filtering system. It can limit the blood supply going to and from the kidneys.

Renovascular diseases are diseases of the arteries to the kidneys. High blood pressure and/or kidney failure can result from these diseases.

The information here can help you talk with your doctor about treatment.

What are the types of renovascular diseases?

There are two main diseases of the renal (kidney) arteries:

  • Atherosclerotic renal artery stenosis (AS-RAS), and
  • Fibromuscular dysplasia (FMD)

Atherosclerosis is better known as hardening of the arteries. It is a common disease. Atherosclerosis is the cause of 9 out of 10 renovascular disease cases. It can involve the large and/or small branches of the renal artery. People with diabetes, aortoiliac occlusive disease, coronary artery disease or other forms of high blood pressure are at risk.

The main risk factors for AS-RAS are:

  • High blood pressure
  • High cholesterol
  • Older age
  • Smoking
  • Diabetes
  • Heavy alcohol use or drug abuse

If you have AS-RAS you may have ongoing narrowing of the renal artery. This means that the arteries continue to narrow for many years, even after treatment. Many arteries can become totally blocked. For some people, their kidney shrinks. AS-RAS is seen if you have diabetes or similar problems. This disease can be missed if hypertension or kidney dysfunction doesn't occur.

Fibromuscular dysplasia (FMD) is a group of vascular diseases that affect the linings of the renal artery. About 10% of AS-RAS cases also have FMD. It is more common in women and people between age 25 and 50. FMD involves the main renal artery and its branches. It looks like beads in the arteries with imaging tests (angiograms). It rarely leads to total artery block, but it is still a problem.

The cause of FMD is not known, though some experts think genetics play a role. Smoking, hormones and disorders of the blood supply to the renal artery may also play a role.



What are the Signs of a Problem?

Renovascular disorders cause high blood pressure, often extreme. Sometimes it's hard to tell if hypertension is from renal artery problems or something else.

Some signs of renovascular diseases are:

  • High blood pressure at an early age
  • Extremely high blood pressure that can't be controlled
  • Kidney dysfunction
  • Narrowing of arteries throughout the body
  • Signs of malignant hypertension (headaches, confusion, nausea, vision changes)


How are Renovascular Diseases Diagnosed?

A general exam, with blood and urine tests, will show problems. Your health care provider may then order more studies. These diseases can be diagnosed with a group of tests that evaluate your overall kidney function and blood flow.

Imaging tests to see if your renal arteries have narrowed include:

  • A doppler ultrasound of the renal arteries
  • A renal angiogram to see a silhouette of the renal artery
  • A 3D CT renal angiogram to see the cause of renal artery stenosis; to see the extent of the disease; to see if the aorta is blocked


What are Some Treatment Options?

Without treatment, renovascular disease can be deadly. Fortunately treatment is available. The goal of treatment is to control blood pressure and prevent kidney failure.

Lifestyle Changes

If you smoke, your health care team (and your loved ones) will suggest that you stop. You will also be asked to change your diet and do more exercises to improve your heart health. Maintaining healthy lifestyle habits have been proven to help.

Medicine

With lifestyle changes, treatment often starts with medicine to control blood pressure. It can also include aspirin, cholesterol-lowering drugs, and drugs for other conditions. High blood pressure pills are very good at controlling blood pressure, but the disease may go on to block arteries. Your medical team will aim to prevent the loss of kidney tissue and progressive kidney failure. This is more difficult if renal artery stenosis hurts both kidneys.

Surgical Procedures

If you need more treatment, your doctor may recommend surgery. Endovascular procedures are used to remove blocks in your kidney arteries. These treatments can restore blood flow to your kidneys. When blood flow returns, your kidneys can function and high blood pressure may lower.

Balloon angioplasty is a common treatment for blocks in the renal artery. It is done inside the blood vessel with a tiny balloon on the end of a small, flexible tube, called a catheter. It is important to find a doctor with special training for this. In atherosclerotic disease, a renal artery stent may also be done. Research has shown that this helps for a while, but more treatment may be needed over time.

Surgical revascularization (surgery to renew blood flow) may be needed. It is used when medicine, balloon angioplasty and stent placement don't help enough. This is also used when kidney failure is found. There are many surgical procedures available to renew blood flow. For example, aortorenal bypass grafts and extra anatomic bypass procedures.

If you need a more complex procedure called bench surgery. This includes a kidney transplant, with the reconstruction of the renal vessel.



What Can be Expected After Treatment?

After treatment, you can expect your blood pressure to improve. Also, your kidneys will begin to function better. Still, careful follow-up after treatment is important with this diagnosis.

The disease has been seen to come back after 3 years in about 15% of people with mural dysplasia after treatment. For AS-RAS, about 44% of people find that it’s still hard to control blood pressure or kidney failure after treatment.



More Information

Frequently asked questions

Can renovascular disease lead to kidney failure?

Yes. Signs of oncoming kidney failure are:

  • Puffy eyes, hands and feet
  • Loss of appetite
  • Nausea and vomiting
  • A bad taste in the mouth
  • Weight loss
  • General and ongoing itchy skin
  • Muscle twitching or cramping
  • A yellowish-brown tint to skin color

As kidney failure gets worse, and toxins build-up in the body, seizures and mental confusion can occur.

What are some complications of renovascular disease?

Some problems that go along with renovascular disease can be: heart disease, stroke, heart attack, congestive heart failure, blood vessel damage, kidney failure/damage and loss of vision.

Can renovascular disease be prevented?

No. But, it can be slowed by controlling conditions that can cause it, like hypertension. Eating a healthy diet is always helpful.