Renal artery stenosis

Question 1

Define:

Answer 1

Narrowing of the renal artery

Question 2

Aetiology/risk factors:

Answer 2

Due to hypoperfusion of the kidneys which leads to a release of renin from the juxtaglomerular cells (detected by the macula densa)

This leads to an increase in BP and so fibrosis, glomerulosclerosis and renal failure.

Question 3

What are the causes of renal artery stenosis?

Answer 3

85% due to atherosclerosis (often in the elderly pts)

10% due to fibromuscular dysplasia

Question 4

Epidemiology:

Answer 4

prevalence is unknown

Fibromuscular dysplasia is main in women <45 years

1-5% of all hypertension cases

Question 5

Symptoms:

Answer 5

HX of Hypertension <50yrs
Hypertension not responding to treatment and worse on ACEi.

DO NOT GIVE ACEI IN RENAL ARTERY STENOSIS AS LEADS TO RENAL DETERIORATION.

Hx of flash oedema

SOB, nausea, fatigue, swelling, reduced ruin and may have chest pain.

Question 6

Signs:

Answer 6

HTN resistant to treatment

Signs of bilateral renal failure - SOB, nausea, fatigue, swelling, reduced ruin and may have chest pain

Renal, femoral, carotid or abdominal bruits

Weak leg pulses

Question 7

Investigations:

Answer 7

Serum creatinine 
potassium 
urinanalysis
Duplex USS
USS
CT/MR angiogram (there is a risk of the contrast leading to nephrotoxicity)

DIGITAAL SUBTRACTION RENAL ANGIOGRAPHY = GOLD STANDARD

renal scintigraphy