Renal Artery Atherosclerosis

Abstract

Atherosclerosis is the most common renal artery disease in adults, accounting for two thirds of all stenotic lesions (Fergany et al. 1995). Fibromuscular dysplasia accounts for the remaining third (Libertino and Beckmann 1994). Renal angiography often demonstrates uni- or bilateral atherosclerotic renal artery lesions, concurrent with atherosclerotic lesions of the abdominal aorta as well as vessels of other organ systems, especially of the coronary vessels (Dean et al. 1984; Novick et al. 1987; Tarazi et al. 1987; O’Mara et al. 1988; Allen et al. 1993). Atherosclerotic stenosis of the renal artery (RAS) characteristically involves the proximal segment of the artery extending from lesions of the aorta (Fig. 6.1). The left renal artery is most frequently affected, but bilateral lesions (Fig. 6.2) are seen in 30%–40% of patients (Libertino and Beckmann 1994). In the renal artery as in other arteries, atherosclerosis is more common in men than women. The mean age at the time of diagnosis is approximately 55 years. Estimates of the prevalence of atherosclerotic RAS vary from less than 1% to 10% (Ram 1992) of the hypertensive population. However, Scoble and colleagues (1989) observed a prevalence of atherosclerotic RAS as high as 14% in patients older than 50 years who were referred to a dialysis program.