Clinical Case Database / Category: Patient Management

Renal artery stenosis

Publication details

Mr Aditya Prinja MA (Cantab), MB BS, MRCS, Miss Kiki Mistry BSc, MB BS, MRCS, Mr Shiva Dindyal BSc (Hons)(Lond), MB BS (Hons)(Lond), MRCS (Edin), MRCS (Eng)
Foundation Years Journal, volume 7, issue 5, p.54 (123Doc Education, London, May 2013)

Abstract

Hypertension and renal impairment are common problems encountered in patients on hospital wards. Whilst most cases of hypertension are primary (or essential hypertension), some cases are secondary. Renal artery stenosis (RAS) is an important cause of secondary hypertension that is increasing in prevalence particularly in the western world, however it remains under diagnosed (1). It is a narrowing of the artery that supplies one or both kidneys. Patients typically present with hypertension and varying degrees of renal impairment, however silent renal artery stenosis may be present in patients with vascular disease. Here, we discuss the aetiology of renal artery stenosis, the clinical features that should make you suspect the diagnosis and importantly which patients would benefit from revascularization and how this is achieved.

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Authors

Mr Aditya Prinja MA (Cantab), MB BS, MRCS

Core Surgical Trainee
Colchester General Hospital,
Essex, UK

Miss Kiki Mistry BSc, MB BS, MRCS

Core Surgical Trainee
The Whittington Hospital,
London, UK

Mr Shiva Dindyal BSc (Hons)(Lond), MB BS (Hons)(Lond), MRCS (Edin), MRCS (Eng)

General Surgery Specialist Registrar/Vascular
and Endovascular Research Fellow
Barts and The London NHS Trust,
Barts and The London School of Medicine and Dentistry,
Circulatory Sciences Clinical Academic Unit,
Vascular and Endovascular Surgical Services,
The Royal London Hospital,
Whitechapel,
London, E1 1BB

References

1. Piecha G, Wiecek A, Januszewicz A. Epidemiology and optimal management in patients with renal artery stenosis. J Nephrol. 2012 Sep 18:0
2. Stacul F, Gava S, Belgrano M et al. Renal artery stenosis: comparative evaluation of gadolinium-enhanced MRA and DSA. Radiol Med. 2008 Jun;113(4):529-46
3. Kalra PA, Guo H, Kausz AT et al. Atherosclerotic renovascular disease in US medicare recipients aged 67 years or more: risk factors, revascularization and prognosis. Kidney Int 2005; 68 (1):293-301
4. Leertouwer TC, Guvsenhoven EJ, Bosch JL et al. Stent placement for renal artery stenosis: where do we stand? A meta-analysis. Radiology 2000; 216:78-85
5. Van de Ven PJG, Kaatee R, Beutler JJ, Beek FJ, Woittiez AJ, Buskens E et al. Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial. Lancet 1999;353:282-6.
6. Tepel M, Aspelin P, Lameire N. Contrast-Induced Nephropathy: A Clinical and Evidence-Based Approach Circulation 2006;113:14 1799-1806
7. Gurm H et al. Contemporary use and effectiveness of N-acetylcysteine in preventing contrast-induced nephropathy among patients undergoing percutaneous coronary intervention. JACC Cardiovasc Interv. 2012 Jan;5(1):98-104
8. McLaughlin K, Jardine AG, Moss JG. ABC of arterial and venous disease. Renal artery stenosis. BMJ. 2000 Apr 22;320(7242):1124-7.
9. Webster J, Marshall F, Abdalla M et al. Randomised comparison of percutaneous angioplasty vs continued medical therapy for hypertensive patients with atheromatous renal artery stenosis. J Hum Hypertension 1998; 12:329-35
10. Astral investigators. Revascularization versus medical therapy for renalartery stenosis. N Engl J Med. 2009 Nov 12; 361(20): 1953-62.

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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