Renal artey stenosis

Question 1

RAS aetiology?

Answer 1

atherosclerosis (older) or fibromuscular dysplasia (younger) (may be associated with micro-aneurysms in the mid and distal renal arteries)

Question 2

RAS pathophysiology?

Answer 2

renal hypoperfusion due to stenosis stimulates the renin-angiotensin system leading to increased angiotensin II and aldosterone, leading to increased BP leading to fibrosis, glomerulosclerosis and renal failure.

Question 3

RAS epidemiology?

Answer 3

1-5% of hypertension, fibromuscular dysplasia occurs mainly in women with hypertension <45.

Question 4

RAS symptoms?

Answer 4

hist of hypertension in <50s,

hypertension refractory to treatment,

accelerated hypertension and renal deterioration on starting ACE inhibitors

Question 5

RAS signs?

Answer 5

hypertension, signs of renal failure in advanced bilateral disease, renal artery bruits

Question 6

RAS investigations?

Answer 6

Duplex USS,

to measure kidney size,

Digital subtraction angiography is the gold standard.