Renal Artery Disease

  • Jeffrey W. Olin
Chapter

Abstract

Renal artery stenosis (RAS) is most commonly due to either fibromuscular dysplasia or atherosclerosis. Fibromuscular dysplasia is found most commonly in young women with hypertension, while atherosclerosis usually is found in individuals over age 55 years presenting with hypertension, renal failure (ischemic nephropathy), or congestive heart failure. Renal artery stenosis may be discovered incidentally (atrophic or small kidney) during imaging studies for other reasons or at autopsy. Incidental RAS is quite common, while renovascular hypertension occurs only in 1% to 5% of all patients with hypertension.

Keywords

Renal Artery Renal Artery Stenosis Renovascular Hypertension Surgical Revascularization Left Renal Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Olin JW, Wholey M: Rupture of the renal artery nine days after percutaneous transluminal angioplasty. JAMA 1987, 257: 518–519.PubMedCrossRefGoogle Scholar
  2. 2.
    Olin JW, Begelman SM: Renal artery disease. In Textbook of Cardiovascular Medicine, edn 4. Edited by Topol E. Philadelphia: Lippincott Raven; 2002: 2139–2159.Google Scholar
  3. 3.
    Gray BH, Young JR, Olin JW: Miscellaneous arterial diseases. In Peripheral Vascular Diseases, edn 4. Edited by Young JR, Olin JW, Bartholomew JR. St. Louis: CV Mosby; 1996: 425–440.Google Scholar
  4. 4.
    Begelman S, Olin JW: Fibromuscular dysplasia. Curr Opin Rheumatol 2000, 12: 41–47.PubMedCrossRefGoogle Scholar
  5. 5.
    Harrison EG, McCormack LJ: Pathologic classification of renal arterial disease in renovascular hypertension. Mayo Clin Proc 1971, 46: 161–167.PubMedGoogle Scholar
  6. 6.
    Olin JW, Novick AC: Renovascular disease. In Peripheral Vascular Diseases, edn 2. Edited by Young JR, Olin JW, Bartholomew JR. St. Louis: CV Mosby; 1996: 321–342.Google Scholar
  7. 7.
    Stanley JC, Gewertz BL, Bove EL, et al.: Arterial fibroplasia, histopathologic character and current etiologic concepts. Arch Surg 1975,110:561–566.Google Scholar
  8. 8.
    Stokes JB, Bonsib SM, McBride JW: Diffuse intimal fibromuscular dysplasia with multiorgan failure. Arch Intern Med 1996, 156: 2611–2614.PubMedCrossRefGoogle Scholar
  9. 9.
    Olin JW, Melia M, Young JR, et al.: Prevalence of atherosclerotic renal artery stenosis in patients with atherosclerosis elsewhere. Am J Med 1990, 88:46N–51N.Google Scholar
  10. 10.
    Scoble JE: The epidemiology and clinical manifestations of atherosclerotic renal disease. In Renal Vascular Disease. Edited by Novick A, Scoble J, Hamilton G. London: WB Saunders; 1996: 143–149.Google Scholar
  11. 11.
    Dustan HP, Humphries AW, De Wolfe VG, et al.: Normal arterial pressure in patients with renal arterial stenosis. JAMA 1964, 187:1028–1029.Google Scholar
  12. 12.
    Harding MB, Smith LR, Himmelstein SI, et al.: Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization. J Am Soc Nephrol 1992, 2:1608–1616.Google Scholar
  13. 13.
    Holley KE, Hunt JC, Brown AL, et al.: Renal artery stenosis: a clinical-pathologic study in normotensive and hypertensive patients. Am J Med 1964, 37:14–22.Google Scholar
  14. 14.
    Wollenweber J, Sheps SG, Davis GD: Clinical course of atherosclerotic renovascular disease. Am J Cardiol 1968, 21 (1): 60–71.PubMedCrossRefGoogle Scholar
  15. 15.
    Dean RH, Kieffer RW, Smith BM, et al.: Renovascular hypertension. Arch Surg 1981,116:1408–1415.Google Scholar
  16. 16.
    Tollefson DFJ, Ernst CB: Natural history of atherosclerotic renal artery stenosis associated with aortic disease. J Vasc Surg 1991, 14: 327–331.PubMedCrossRefGoogle Scholar
  17. 17.
    Rimmer JM, Gennari FJ: Atherosclerotic renovascular disease and progressive renal failure. Ann Intern Med 1993, 118: 712–719.PubMedCrossRefGoogle Scholar
  18. 18.
    Goldblatt H, Lynch J, Hanzal RF, Summerville WW: Studies in experimental hypertension. I. The production of persistent elevation of systolic blood pressure by means of renal ischemia. J Exp Med 1934, 59: 347–379.PubMedCrossRefGoogle Scholar
  19. 19.
    Textor SC, Tarazi RC, Novick AC, et al.: Regulation of renal hemopatients with renovascular hypertension during converting enzyme inhibition with captopril. Am J Med 1984, 76: 29–37.PubMedCrossRefGoogle Scholar
  20. 20.
    Hricik D, Browning PJ, Kopelman R, et al.: Captopril-induced unctional renal insufficiency in patients with bilateral renal-artery stenosis or renal-artery stenosis to a solitary kidney. N Engl J Med 43. 1983, 308:373–376.Google Scholar
  21. 21.
    Gifford RW Jr, McCormack LJ, Poutasse EF: The atrophic kidney: its role in hypertension. Mayo Clin Proc 1965, 40: 834–852.PubMedGoogle Scholar
  22. 22.
    Carman T, Olin JW, Czum J: Noninvasive imaging of renal arteries. Urol Clin North Am 2001, 28: 815–826.PubMedCrossRefGoogle Scholar
  23. 23.
    Lawrie GM, Morris GC, Debakey ME: Long-term results of treat- ment of the totally occluded renal artery in patients with reno 46. vascular hypertension. Surgery 1980, 88: 753–759.PubMedGoogle Scholar
  24. 24.
    Carman TK, Olin JW: Diagnosis of renal artery stenosis: what is the optimal test? Curr Intery Cardiol Rep 2000, 2: 111–118.Google Scholar
  25. 25.
    Nally W: Captopril Renal Flow Scan. Urol Clin North Am 1994, 21: 232.Google Scholar
  26. 26.
    Nally IV, Clarke HS, Jr, Grecos GP, et al.: Effect of captopril on renograms in two kidney, one clip hypertension. Hypertension 1986, 8:685–693.Google Scholar
  27. 27.
    Nally JV, Barton DP: Contemporary approach to the diagnosis and evaluation of renovascular hypertension. Urol Clin North Am 2001, 49. 28: 781–91.CrossRefGoogle Scholar
  28. 28.
    Black HR, Bourgoignie JJ, Pickering T, et al.: Report of the working party group for patient selection and preparation. Am J Hypertens 50. 1991, 4:745S–746S.Google Scholar
  29. 29.
    Prigent A, Cosgriff P, Gates GF, et al.: Consensus report on quality control of quantitative measurements of renal function obtained from the renogram: International Consensus Committee from the Scientific Committee of Radionuclides in Nephrourology. Semin Nucl Med 1991, 29:146–159.Google Scholar
  30. 30.
    Fommei E, Ghione S, Hilson AJW, et al.: Captopril radionuclide test in renovascular hypertension: a European multicentre study. Eur J Nucl Med 1994, 20:617–623.Google Scholar
  31. 31.
    Geyskes GG, Oei HY, Puylaert CBAJ, et al.: Renography with captopril. Changes in a patient with hypertension and unilateral renal artery stenosis. Arch Intern Med 1986, 146:1705–1708.Google Scholar
  32. 32.
    Mann SJ, Pickering RG, Sos TA, et al.: Captopril renography in the diagnosis of renal artery stenosis: accuracy and limitations. Am J Med 1991, 90:30–40.Google Scholar
  33. 33.
    van Jaarsveld BC, Krijnen P, Derkx FH, et al.: The place of renal scintigraphy in the diagnosis of renal artery stenosis. Fifteen years of clinical experience. Arch Intern Med 1997, 157:1226–1234.Google Scholar
  34. 34.
    Sfakianakis GN, Bourgoignie JJ, Daffe D, et al.: Single dose captopril scintigraphy in the diagnosis of renovascular hypertension. J Nucl Med 1987, 28:1383–1392.Google Scholar
  35. 35.
    Erbsloh-Moller B, Dumas A, Roth E, et al.: Furosemide 131Ihippuran renography after angiotensin-converting enzyme inhibition for the diagnosis of renovascular hypertension. Am J Med 1991, 90:23–40.Google Scholar
  36. 36.
    Svetkey LP, Kadir S, Dunnick NR, et al.: Similar prevalence of renovascular hypertension in selected blacks and whites. Hypertension 1991, 17:678–683.Google Scholar
  37. 37.
    Setaro JF, Saddler MC, Chen CC, et al.: Simplified captopril renography in diagnosis and treatment of renal artery stenosis. Hypertension 1991, 18(3):289–298.Google Scholar
  38. 38.
    Dondi M: Captopril renal scintigraphy with 99mTc-mercaptoacetyliglycine (99mTc-MAG3) for detecting renal artery stenosis. Am J Hypertens 1991, 4: 7375–740S.CrossRefGoogle Scholar
  39. 39.
    Elliott WJ, Martin WB, Murphy MB: Comparison of two noninvasive screening tests for renovascular hypertension. Arch Intern Med 1993, 153: 755–764.PubMedCrossRefGoogle Scholar
  40. 40.
    Mittal BR, Kumar P, Arora P, et al.: Role of captopril renography in the diagnosis of renovascular hypertension. Am J Kidney Dis 1996, 28:209–213.Google Scholar
  41. 41.
    Miralles M, Covas MI, Martinez ME, et al.: Captopril test and renal duplex scanning for the primary screening of renovascular disease. Am J Hypertens 1997, 10:1290–1296.Google Scholar
  42. 42.
    Johansson M, Jensen G, Aurell M, et al.: Evaluation of duplex ultrasound and captopril renography for detection of renovascular hypertension. Kidney Int 2000, 58:774–782.Google Scholar
  43. 43.
    Olin JW: Role of duplex ultrasonography in screening for significant renal artery stenosis. Urol Clin North Am 1994, 21:215–226. Olin JW, Piedmonte MA, Young JR, et al.: Utility of duplex scanning of the renal arteries for diagnosing significant renal artery stenosis. Ann Intern Med 1995, 122:833–838.Google Scholar
  44. 44.
    Hansen KJ, Tribble RW, Reavis SW, et al.: Renal duplex sonography: evaluation of clinical utility. J Vasc Surg 1990, 12:227–236.Google Scholar
  45. 45.
    Hudspeth DA, Hansen KJ, Reavis SW, et al.: Renal duplex sonography after treatment of renovascular disease. J Vasc Surg 1993, 18:381–390.Google Scholar
  46. 46.
    Radermacher J, Clavan A, Bleck J, et al.: Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med 2001, 344:410–417.Google Scholar
  47. 47.
    Thornton MJ, Thornton F, O’Callaghan J, et al.: Evaluation of dynamic gadolinium-enhanced breath-hold MR angiography in the diagnosis of renal artery stenosis. J Am J Radiol 1999, 173:1279–1283.Google Scholar
  48. 48.
    Saloner D: Determinants of image appearance in contrast-enhanced magnetic resonance angiography: a review. Invest Radiol 1998, 33: 488–495.PubMedCrossRefGoogle Scholar
  49. 49.
    Hahn U, Miller S, Nagele T, et al.: Renal MR angiography at 1.0 T: three-dimensional (3D) phase-contrast techniques versusGoogle Scholar
  50. 50.
    gadolinium-enhanced 3D fast low-angle shot breath-hold imaging. J Am J Radiol 1999, 172: 1501–1508.Google Scholar
  51. 51.
    Schreier DZ, Weaver FA, Frankhouse J, et al.: A prospective study of carbon dioxide-digital subtraction vs. standard contrast arteriography in the evaluation of the renal arteries. Arch Surg 1996, 131:503–508.Google Scholar
  52. 52.
    Caridi JG, Hawkins IF Jr: CO2 digital subtraction angiography: potential complications and their prevention. J Vasc Intery Radiol 1997, 8: 383–391.CrossRefGoogle Scholar
  53. 53.
    Meaney TF, Dustan HP, McCormack LJ: Natural history of renal arterial disease. Radiology 1968, 91 (5): 881–887.PubMedGoogle Scholar
  54. 54.
    Schreiber MJ, Pohl MA, Novick AC: The natural history of atherosclerotic and fibrous renal artery disease. Urol Clin North Am 1984, 11: 383–392.PubMedGoogle Scholar
  55. 55.
    Crowley JJ, Santos Rivi, Peter RH, et al.: Progression of renal artery stenosis in patients undergoing cardiac catheterization. Am Heart J 1998, 136:913–918.Google Scholar
  56. 56.
    Caps MT, Perissinotto C, Zierler RE et al.: Prospective study of atherosclerotic disease progression in the renal artery. Circulation 1998, 98:2866–2872.Google Scholar
  57. 57.
    Caps MT, Zierler RE, Polissar NL, et al.: Risk of atrophy in kidneys with atherosclerotic renal artery stenosis. Kidney Int 1998, 53:735–742.Google Scholar
  58. 58.
    Mallioux LU, Napolitano B, Bellucci AG, et al.: Renal vascular disease causing end-stage renal disease, incidence, clinical correlates, and outcomes: a 20-year clinical experience. Am J Kidney Dis 1994, 24:622–629.Google Scholar
  59. 59.
    USRDS 1993 Annual Data Report. National Institutes of Diabetes and Digestive Diseases. Bethesda, MD: The National Institutes of Health; 1993.Google Scholar
  60. 60.
    Connolly JO, Higgins RM, Walters HL, et al.: Presentation, clinical features and outcome in different patterns of atherosclerotic renovascular disease. Q J Med 1994, 87:413–421.Google Scholar
  61. 61.
    Conlon PJ, O’Riordan E, Kalra P: New insights into the epidemiologic and clinical manifestations of atherosclerotic renovascular disease. Am J Kid Dis 2000, 35: 573–587.PubMedCrossRefGoogle Scholar
  62. 62.
    Dorros G, Jaff M, Mathiak L, et al.: Four-year follow-up of PalmazSchatz stent revascularization as treatment for atherosclerotic renal artery stenosis. Circulation 1998, 98:642–647.Google Scholar
  63. 63.
    The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997, 157: 2413–2446.CrossRefGoogle Scholar
  64. 64.
    Antiplatelet Trialists’ Collaboration: Collaborative meta-analysis of randomized trials of antiplatelet therapy for the prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002, 324: 71–86.CrossRefGoogle Scholar
  65. 65.
    The Heart Outcomes Prevention Evaluation Study Investigators: effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000, 342:145–153.Google Scholar
  66. 66.
    Jaff MR, Olin JW: Revascularization of atherosclerotic renal artery stenosis: Indications for intervention. Texas Heart J 1998, 25: 34–39.Google Scholar
  67. 67.
    Pickering TG, Herman L, Devereux RB, et al.: Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularization. Lancet 1988, 2:551–552.Google Scholar
  68. 68.
    Van Bockel JH, Van Den Akker PJ, Chang PC, et al.: Extracorporeal renal artery reconstruction for renovascular hypertension. J Vasc Surg 1991, 13:101–110.Google Scholar
  69. 69.
    Novick AC, Ziegelbaum M, Vidt DG, et al.: Trends in surgical revascularization for renal artery disease. JAMA 1987, 257:498–501.Google Scholar
  70. 70.
    Libertino JA, Elam TA, Zinman LN, et al.: Changing concepts in surgical management of renovascular hypertension. Arch Intern Med 1988, 148:357–359.Google Scholar
  71. 71.
    Hansen KJ, Starr SM, Sands E, et al.: Contemporary surgical management of renovascular disease. J Vasc Surg 1992,16:319–330.Google Scholar
  72. 72.
    Tarazi RY, Hertzer NR, Beven EG, et al.: Simultaneous aortic reconstruction and renal revascularization: risk factors and late results in 89 patients. J Vasc Surg 1987, 5:707–714.Google Scholar
  73. 73.
    Brewster DC, Darling RC: Splenorenal arterial anastomosis for renovascular hypertension. Ann Surg 1979, 189: 353–358.PubMedCrossRefGoogle Scholar
  74. 74.
    Hallett JW, Fowl R, O’Brien PC, et al.: Renovascular operations in patients with chronic renal insufficiency: do the benefits justify the risks? J Vasc Surg 1987, 622–627.Google Scholar
  75. 75.
    Bredenberg CE, Sampson LN, Ray FS, et al.: Changing patterns in surgery for chronic renal artery occlusive diseases. J Vasc Surg 1992, 15:1018–1023.Google Scholar
  76. 76.
    Zinman L, Libertino JA: Revascularization of the chronic totally occluded renal artery with restoration of renal function. J Urol 1977, 18: 517–521.Google Scholar
  77. 77.
    Olin JW, Young JR, Graor RA: Thrombolytic therapy for renal artery occlusions. Cleve Clin J Med 1989, 56: 432–438.PubMedCrossRefGoogle Scholar
  78. 78.
    Kaylor WM, Novick AC, Ziegelbaum M, Vidt DG: Reversal of end stage renal failure with surgical revascularization in patients with atherosclerotic renal artery occlusion. J Urol 1989, 141: 486 488.Google Scholar
  79. 79.
    Hansen KJ, Thomason RB, Craven TE, et al.: Surgical management of dialysis-dependent ischemic nephropathy. J Vasc Surg 1995, 21:197–209.Google Scholar
  80. 80.
    Wilms GE, Peene PT, Baert AL, et al.: Renal artery stent placement with the use of the Wallstent endoprosthesis. Radiology 1991, 179:457–462.Google Scholar
  81. 81.
    Kuhn FP, Kutkuhn B, Torsello G, Modder U: Renal artery stenosis: preliminary results of treatment with the Strecker stent. Radiology 1991, 180: 367–372.PubMedGoogle Scholar
  82. 82.
    Rees CR, Palmaz JC, Becker GJ, et al.: Palmaz stent in atherosclerotic stenosis involving the ostia of the renal arteries: preliminary report of a multicenter study. Radiology 1991,181:507–514.Google Scholar
  83. 83.
    Hennequin LM, Joffre FG, Rousseau HP, et al.: Renal artery stent placement: long-term results with the Wallstent endoprosthesis. Radiology 1994, 191:713–719.Google Scholar
  84. 84.
    Van de Ven PJ, Kaatee R, Beutler JJ, et al.: Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease. A randomised trial. Lancet 1999, 353:282–286.Google Scholar
  85. 85.
    Henry M, Amor M, Henry I, et al.: Stent placement in the renal artery: three-year experience with the Palmaz stent. J Vasc Intery Radiol 1996, 7:343–350.Google Scholar
  86. 86.
    Iannone LA, Underwood PL, Nath A, et al.: Effect of primary balloon expandable renal artery stents on long-term patency, renal function and blood pressure in hypertensive and renal insufficient patients with renal artery stenosis. Cathet Cardiovasc Diagn 1996, 37:243–250.Google Scholar
  87. 87.
    Blum U, Krumme B, Flugel P, et al.: Treatment of ostial renal-artery stenosis with vascular endoprostheses after unsuccessful balloon angioplasty. N Engl J Med 1997, 336:459–465.Google Scholar
  88. 88.
    Boisclair C, Therasse E, Oliva VL, et al.: Treatment of renal angioplasty failure by percutaneous renal artery stenting with Palmaz stents: midterm technical and clinical results. Am J Roentgenol 1997,168:245–251.Google Scholar
  89. 89.
    Harden PN, MacLeod MJ, Rodger RS, et al.: Effect of renal-artery stenting on progression of renovascular renal failure. Lancet 1997, 349:1113–1136.Google Scholar
  90. 90.
    White CJ, Ramee SR, Collins TJ, et al.: Renal artery stent placement: Utility in lesions difficult to treat with balloon angioplasty. J Am Coll Cardiol 1997, 30:1445–1450.Google Scholar
  91. 91.
    Rundback JH, Gray RJ, Rozenblit G, et al.: Renal artery stent placement for the management of ischemic nephropathy. J Vasc Intery Radiol 1998, 9:413–420.Google Scholar
  92. 92.
    Shannon HM, Gillespie IN, Moss JG: Salvage of the solitary kidney by insertion of a renal artery stent. Am J Roentgenol 1998, 171: 217–222.CrossRefGoogle Scholar
  93. 93.
    Dorros G, Jaff M, Mathiak L, et al.: Four-year follow-up of PalmazSchatz stent revascularization as treatment for atherosclerotic renal artery stenosis. Circulation 1998, 98:642–647.Google Scholar
  94. 94.
    Watson PS, Hadjipetrou P, Cox SV, et al.: Effect of renal artery stenting on renal function and size in patients with atherosclerotic renovascular disease. Circulation 2000,102:1671–1677.Google Scholar
  95. 95.
    Leertouwer TC, Gussenhoven EJ, Bosch JL, et al.: Stent placement for renal arterial stenosis: where do we stand? A meta-analysis. Radiology 2000, 216:78–85.Google Scholar
  96. 96.
    Gray B, Olin JW, Sullivan TM, et al.: Renal artery angioplasty with stenting in patients with congestive heart failure. Vasc Med 1998, 3:325.Google Scholar
  97. 97.
    Pickering TG, Herman L, Devereux RB, et al.: Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularization. Lancet 1988, 2:551–552.Google Scholar
  98. 98.
    Diamond JR: Flash pulmonary edema and the diagnostic suspicion of occult renal artery stenosis. Am J Kidney Dis 1993, 21: 328–330.PubMedGoogle Scholar
  99. 99.
    Khosla S, White CJ, Collins TJ, et al.: Effects of renal artery stent implantation in patients with renovascular hypertension presenting with unstable angina or congestive heart failure. Am J Cardiol 1997, 80:363–366.Google Scholar
  100. 100.
    Walker F, Walker DA, Nielson M: Flash pulmonary oedema. Lancet 2001, 358: 556.PubMedCrossRefGoogle Scholar
  101. 101.
    Basaria S, Fred HL: Flash pulmonary edema heralding renal artery stenosis. Circulation 2002, 105: 899.PubMedCrossRefGoogle Scholar
  102. 102.
    Messina LM, Zelenock GB, Yao KA, Stanley JC: Renal revascularization for recurrent pulmonary edema in patients with poorly controlled hypertension and renal insufficiency: a distinct subgroup of patients with atherosclerotic renal artery occlusive disease. J Vasc Surg 1992, 15: 73–80.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • Jeffrey W. Olin

There are no affiliations available

Personalised recommendations