Challenges in the diagnosis and management of renal artery stenosis.
Renal artery stenosis (RAS) is a common cause of secondary hypertension, with the activation of the renin-angiotensin-aldosterone system being the pathophysiologic hallmark of the disease. Renovascular hypertension, ischemic nephropathy, proteinuria, and flash pulmonary edema are the main clinical syndromes associated with RAS. The prevalence of RAS is on the rise, owing to an increasing prevalence of diabetes and atherosclerotic disease among our aging population. This rise in RAS prevalence poses major challenges for clinicians making diagnostic and treatment decisions. Although renal angioplasty is of proven benefit in fibromuscular dysplasia, randomized trials in atherosclerotic RAS have not shown any advantage for revascularization over medical therapy in terms of blood pressure control or renal function preservation. Angioplasty and surgical interventions should be reserved for patients with preserved kidney size and hemodynamically significant stenosis.
Salifu
Moro O
MO
Renal Fellowship Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 52, Brooklyn, NY, 11203, USA. moro@salifu.net
Haria
Dhiren M
DM
Badero
Olurotimi
O
Aytug
Serhat
S
McFarlane
Samy I
SI
D017130:Angioplasty; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D015607:Stents
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents