Renal Artery Stenosis

Posted by e-Medical PPT Thursday, November 4, 2010
Renal artery stenosis is the narrowing of the renal artery, most often caused by atherosclerosis or fibromuscular dysplasia.Atherosclerosis is the predominant cause of renal artery stenosis in the majority of patients, usually those with a sudden onset of hypertension at age 50 or older. Fibromuscular dysplasia is the predominant cause in young patients, usually females under 40 years of age.
The macula densa of the kidney detects the decreased systemic blood pressure owing to the reduced blood flow through the narrowed artery. The response of the kidney to this perceived decreased blood pressure is activation of the renin-angiotension aldosterone system, which normally counteracts low blood pressure but in this case leads to hypertension.The decreased perfusion pressure leads to decreased blood flow to the kidney and a decrease in the GFR.If the stenosis is longstanding and severe the GFR in the affected kidneys never increases again and renal failure is the result.
Most cases of renal artery stenosis are asymptomatic, and the main problem is high blood pressure that cannot be controlled with medication. Deterioration in renal function may develop if both kidneys are poorly supplied, or when treatment with an ACE inhibitor is initiated. Some patients present with episodes of flash pulmonary edema.
Diagnosis can be made by captopril challenge test and renal artery arteriogram.
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