Renal artery stenosis: symptoms and treatment in Turkey

Renal artery stenosis: symptoms and treatment

Renal artery stenosis is the narrowing of the artery supplying the kidneys, which leads to secondary hypertension and which can be treated in Turkey before it is too late, either by catheterization or surgery.

What is renal artery stenosis?

Renal artery stenosis is the narrowing of the artery that supplies the kidneys to either one or both sides (i.e., to one or both kidneys).
Stenosis occurs in 80 % cases due to hardening of the arteries, the main artery (aorta) and artery branching from it (kidney).
As a result, arterial hypertension caused by activation of the renin-angiotensin-aldosterone system can develop.
Therefore, renal artery stenosis is often accompanied by high blood pressure.

This affects most elderly smokers as well. Also, 20 % patients had congenital renal artery stenosis (especially women).
In this condition, stenosis of the renal arteries is caused by the muscles of the vessel wall and the structure of the connective tissue in the vessel.

Types of renal artery stenosis

Atherosclerotic stenosis of the renal arteries

Renal artery stenosis is caused by atherosclerosis. This type of renal artery stenosis is particularly common in older adults.

The problem of multiple sclerosis may lead to narrowing of the renal artery, which limits the blood supply to the kidney
An image showing stenosis of the right renal artery due to multiple sclerosis

Fibromuscular renal artery stenosis

In this form of the disease, the thickness of the vascular wall of the renal artery increases, thus narrowing the opening of the blood vessels. This form mainly affects young people.

In 1% to 5% of all cases, renal artery stenosis is the cause of hypertension.

Fibromuscular dysplasia leads to arterial lumen distortion and renal artery stenosis
Picture of a renal artery with multiple stenosis due to fibromuscular dysplasia

 Causes of narrowing of the kidney arteries

Atherosclerosis

It is the most common cause of renal artery stenosis, accounting for 60% to 90% cases.
It mainly occurs at the junction between the aorta and the renal arteries.

fibromuscular dysplasia

It is a change in the vascular connective tissue.
Renal artery stenosis is more common in young patients and most likely occurs in the middle third of the renal artery.

Arterial infections

Such as Takayasu's arteritis (unspecified aortitis).

Other rare causes

Such as injuries or aneurysms of the renal artery or thrombosis.

The pathophysiology of renal artery stenosis may be explained by the Goldblatt effect. If the diameter of the renal artery is reduced to less than 40 percent, the blood flow in the kidney is reduced.
The kidneys react to reduced blood flow leading to increased release of renin, which via the renin-angiotensin-aldosterone system leads to vasoconstriction (vasoconstriction) and increased sodium and water reabsorption.
This results in an increase in systemic blood pressure.

In this way, the diseased kidneys try to improve the restricted blood flow, but they also increase the pressure in the body's circulation to values that are considered satisfactory.

Symptoms of renal artery stenosis

It is not always necessary for the disease to have symptoms, but it can also go without symptoms.
However, vascular hypertension occurs in many cases. And
It is high blood pressure caused by kidney disease. Additionally, blood flow to the kidneys is reduced, which can lead to kidney impairment.

Renal ischemia due to renal artery stenosis induces conversion of prerenal prerenal in the kidney to pressure-raising renin
An image showing the mechanism of high pressure in renal artery stenosis

In general, possible symptoms include:

  • High blood pressure (particularly diastolic blood pressure)
  • Decreased effect of the circadian clock on vital processes (that is, it is inconsistent with the day-night cycle)
  • A narrowing sound in the umbilical region (in about 40 percent of patients)
  • In advanced patients, high blood pressure values often develop rapidly

Diagnosis of renal artery stenosis

In lean people, renal artery stenosis can be observed with a stethoscope.
During the physical exam, a flowing noise is heard in the abdomen and waist area, which indicates changes in the blood vessels of the kidneys.
Vascular change is primarily diagnosed by ultrasound examination of the kidneys and blood vessels.

During the examination, the rate of blood flow through the vessels and the width of the vessel can be measured.

If significant constriction can be detected with a low flow velocity, treatment is necessary.
X-rays are not used in the ultrasound examination, which is why it is especially convenient for the patient.

Another option is what is known as magnetic resonance angiography, in which the renal vessels are shown very precisely.
Here the patient is injected with a contrast medium intravenously, with which the renal vessels can be clearly visible.

Renal artery stenosis treatment

The following treatment options are available:

Drug therapy

ACE inhibitors are used with beta-blockers as medicine. But when drug treatment fails, and when there is no improvement in blood pressure values, surgical procedures become an option.

NoticeableIn the case of renal artery stenosis of both kidneys or if only one kidney is present, treatment with ACE inhibitors can lead to acute renal failure and is not recommended in this case.

 

Interventional Therapy - Percutaneous Angioplasty (PTA .)

Percutaneous angioplasty (PTA) is successful in 80% renal artery stenosis, often with subsequent temporary tube implantation. as with Cardiac catheterizationA balloon is pushed into the renal artery through a catheter. This balloon is then expanded at the site of the defect to expand the vessel.
If necessary, a temporary intravascular tube may be used. The temporary tube is intended to ensure that the blood vessel remains open

PTA is only performed if pharmacological treatment of hypertension does not lead to an adequate decrease in pressure or if the artery is more than 70% occluded and therefore no improvement in hypertension is expected.

Surgical treatment - aorta surgery or anatomical bypass surgery

In rare cases, surgery may be necessary, for example, if catheter treatment is unsuccessful.

During surgery, the narrowed portion of the blood vessel is removed and, if necessary, attached to an artificial vascular tip.

renal artery stenosis alarm

The cause of renal artery stenosis can usually be corrected.

In most cases, a normal blood pressure level can be reached
. But the longer the stenosis remains untreated and the higher the blood pressure, the less chance the blood pressure will drop again, as the body adjusts to the high blood pressure over time.
If high blood pressure persists, what is called persistent high blood pressure occurs.
In addition, if renal artery stenosis is not treated, there is a risk of shrinkage of the kidney and a gradual loss of its function.
An unaffected kidney can then enlarge.

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Common Questions

Renal artery stenosis caused by fibromuscular dysplasia is fatal and may eventually lead to kidney failure.

Because your kidneys don't get enough blood, they respond by making a hormone that raises your blood pressure.

It is estimated that some degree of renal artery stenosis (more than 50%) is present in about 18% of people aged 65-75 years and 42% of those aged over 75 years.

Treatment methods for renal artery stenosis in Turkey are either by catheterization or surgery.

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