Renal artery stenosis

This condition may result in secondary hypertension and secondary hyperaldosteronism. Other possible features include:

• coexistant cerebrovascular, cardiovascular or peripheral vascular disease
• deterioration of renal function following treatment with ACE inhibitor
• abdominal bruit; signs of coexistant vascular disease e.g. carotid or femoral bruit; absent peripheral pulses

A small kidney will be seen on intravenous urography on the affected side with a delayed and persistent nephrogram (1)

RAS is predominantly due to atherosclerosis (>90%) in the adult population (2)

• with fibromuscular dysplasia (FMD) being more common in younger female patients

In consideration of computed tomographic angiography and magnetic resonance angiography (MRA) in comparison to digital subtraction angiography (DSA) in diagnosis of renal artery stenosis (1):

• computed tomographic angiography and MRA are not reproducible or sensitive enough to rule out renal artery stenosis in hypertensive patients
• DSA is the diagnostic method of choice

Reference:

1. Vasbinder GB et al. Accuracy of computed tomographic angiography and magnetic resonace angiography for diagnosis renal artery stenosis. Ann Intern Med 2004;141:674-82
2. de Leeuw PW, Postma CT, Spiering W, Kroon AA. Atherosclerotic Renal Artery Stenosis: Should we Intervene Earlier? Curr Hypertens Rep. 2018 Apr 10;20(4):35