Overview
What Is Renal Artery Stenosis ?
Renal artery stenosis is the narrowing of kidney arteries. When the blood flow is normal through your kidneys, your kidneys rid your body of wastes. The kidneys filter these wastes into your urine, which collects in your bladder, and from there the wastes exit your body when you urinate. Your kidneys also help control your blood pressure by sensing the blood pressure and secreting a hormone, called renin, into your bloodstream. The amount of renin secreted by your kidneys can help regulate your blood pressure if it is too high or too low. When your kidney blood vessels narrow or have a clot, your kidney is less able to do its work. Your physician may diagnose you with renal artery stenosis. This condition may cause high blood pressure and may eventually lead to kidney failure.
Renovascular Conditions
Renovascular conditions affect the renal arteries, which supply blood to the kidneys. The kidneys are responsible for filtering waste out of the body, and for regulating blood pressure by secreting the hormone called renin, that triggers an increase or decrease in blood pressure as needed. When the blood vessels that supply the kidney become blocked, the kidney cannot function correctly. The most commonly diagnosed renovascular conditions are renal artery stenosis and renal vein thrombosis, which are a narrowing of the renal arteries due to plaque build up, and a blockage of the renal arteries due to a blood clot, Stent Placement Surgery respectively.
Both renovascular conditions can cause high blood pressure and kidney failure. Renal artery stenosis is caused by a build up of plaque that occurs inside the artery and causes the artery to become narrow, hardened, and in severe cases totally blocks blood flow. Renal vein thrombosis is caused by a blood clot that blocks the renal arteries stopping adequate blood flow to the kidneys.
What Are The Symptoms ?
You may not notice any symptoms. Renovascular conditions develop slowly and worsen over time. If you have high blood pressure, the first sign that you may have renal artery stenosis is that your high blood pressure may become worse or the medications that you take to control your high blood pressure may not be as effective. Other signs of renal artery stenosis are a whooshing sound in your abdomen that your physician hears through a stethoscope, decreased kidney function, congestive heart failure or, eventually, a small shrunken kidney.
When renal vein thrombosis occurs, a clot in your vein may break free or block the flow in a healthy blood vessel. If this happens,
Symptoms May 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
What Tests Will I Need ?
Your physician will recommend the following tests to help determine if you have renal artery stenosis:
- Ultrasound, which allows your physician to see your blood vessels and organs using high-frequency sound waves. Using ultrasound, your physician can locate clots or narrow areas inside your arteries and also determine the size of your kidney
- Angiography, which is more invasive, can locate a narrowing or blockage, can measure blood flow, and can be used to sample blood for testing. In this test, your physician injects a contrast dye into your vessels through a small catheter and then takes x-rays. The structure inside of your vessels appears on the x-ray because x-rays cannot pass through the dye. This test finds the location and pattern of blockages in your kidney blood vessels. The dye itself is later excreted through your kidneys and it sometimes can affect their function.
- Spiral Computed Tomography (CT) Scan, which creates detailed three-dimensional images from x-rays of slices of your body. This study also sometimes uses contrast dye.
- Magnetic Resonance Angiography (MRA), which uses magnetic fields and radio waves to produce three-dimensional images of your arteries. This study also sometimes uses contrast dye.
- Radionuclide scanning, which uses a radioactive substance and a special camera to analyze the blood flow through your kidney.
Diagnosis
To diagnose renovascular conditions, a physician may order a variety of tests to show the renal blood vessels.
These Ttests Include:
- Blood and urine tests
- Doppler ultrasound
- Computerized tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Magnetic resonance angiography (MRA)
- Venacavography (A contrast agent is injected into the veins and an x ray is taken.)
- Renal arteriography (Similar to venacavography, but provides images of arteries, not veins.)
- Radionuclide scanning (A radioactive substance injected into a patient's bloodstream emits gamma rays, similar to x rays. A gamma camera collects these rays to assess blood flow through the kidneys.)
Treatment Approach
Treatments for renovascular conditions depend on the diagnosis.
They may include:
- Medications that prevent clotting (anticoagulants) or medications that dissolve clots;
- Blood pressure medications (antihypertensives);
- Angioplasty to widen or unblock arteries; or
- Bypass surgery.
Surgery
Two surgical procedures that your physician may use to treat renal artery stenosis are endarterectomy and surgical bypass. In a renal endarterectomy, a vascular surgeon removes the inner lining of your renal artery, which contains the plaque. This procedure removes the plaque and leaves a smooth, wide-open artery.
Bypass surgery creates a detour around the narrowed or blocked sections of your renal artery. To create this bypass, a vascular surgeon connects one of your veins or a tube made from man-made materials, called a bypass graft, above and below the area that is blocked. This creates a new path for your blood to flow to your kidneys.
The choice of the procedure that is best for your situation depends upon the extent and location of the blockages. Your vascular surgeon will advise you regarding which procedure is best for your particular situation.
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