Renal Artery Disease

Renal artery disease refers to disease of the renal arteries (arteries that supply the kidneys) such that symptoms occur from lack of blood flow. The cause is often chronic and progressively worsening atherosclerotic (cholesterol) plaque within one or more of the renal arteries causing stenosis (narrowing) of the artery.

Other possible causes are fibromuscular dyspalsia (FMD), aneurysm, and dissection. FMD is a condition that affects the arterial wall causing stenosis of the artery. Dissection is when the inner wall of an artery tears and blood flows between 2 layers of the artery wall in 2 lumens (channels) known as the ‘false’ lumen (newly created channel within the wall of the artery), and the ‘true’ lumen (the proper lumen that has always existed). The ‘false’ lumen can often cause collapse and occlusion of the ‘true’ lumen and thus lack of blood flow to the affected kidney. Complications from renal artery disease include renal insufficiency or failure, renovascular hypertension, and life-threatening bleeding from rupture of an existing aneurysm.

Diagnosis of renal artery disease requires consultation with both a nephrologist and a vascular surgeon and relies on physical exam, laboratory testing, duplex ultrasound, computed tomography (CT) scan or magnetic resonance imaging (MRI) study, and arteriogram (injection of contrast dye into the arteries).

Treatment of renal artery disease often requires a procedure to improve blood flow to the affected kidney(s). This may include minimally invasive (endovascular) treatment with balloon angioplasty and/or stenting of the affected artery(s). If the patient or circumstances do not allow for this technique, then open surgical revascularization is required.