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ALL / Nephrology
Renal vascular disease
Renal vascular disease
Renal vascular disease is most commonly due to atherosclerosis (> 95% of patients). It is associated with risk factors such as smoking and hypertension that cause atheroma elsewhere in the body. It may present as hypertension, chronic renal failure or 'flash' pulmonary oedema.Another common presentation is a sharp rise in creatinine following the initiation of ACE inhibitor therapy (e.g. hypertension that may itself be linked to the underlying renal artery stenosis).
- ACE inhibitors reduce angiotensin II levels, which normally constrict the efferent arterioles in the glomerulus to maintain glomerular filtration pressure, especially in states of decreased renal perfusion
- in patients with renal artery stenosis, this change can significantly reduce the glomerular filtration rate (GFR), causing a sharp rise in serum creatinine
In younger patients however fibromuscular dysplasia (FMD) needs to be considered. FMD is more common in young women and characteristically has a 'string of beads' appearance on angiography. Patients respond well to balloon angioplasty
Investigation
- MR angiography is now the investigation of choice
- CT angiography
- conventional renal angiography is less commonly performed used nowadays, but may still have a role when planning surgery
+PassMedicine Notes
Renal vascular disease is most commonly due to atherosclerosis (> 95% of patients). It is associated with risk factors such as smoking and hypertension that cause atheroma elsewhere in the body. It may present as hypertension, chronic renal failure or 'flash' pulmonary oedema.
Another common presentation is a sharp rise in creatinine following the initiation of ACE inhibitor therapy (e.g. hypertension that may itself be linked to the underlying renal artery stenosis).- ACE inhibitors reduce angiotensin II levels, which normally constrict the efferent arterioles in the glomerulus to maintain glomerular filtration pressure, especially in states of decreased renal perfusion
- in patients with renal artery stenosis, this change can significantly reduce the glomerular filtration rate (GFR), causing a sharp rise in serum creatinine
In younger patients however fibromuscular dysplasia (FMD) needs to be considered. FMD is more common in young women and characteristically has a 'string of beads' appearance on angiography. Patients respond well to balloon angioplasty
Investigation- MR angiography is now the investigation of choice
- CT angiography
- conventional renal angiography is less commonly performed used nowadays, but may still have a role when planning surgery