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Renal artery stenosis
What's new
Updated 2024 ESC guidelines for the evaluation and management of renal artery stenosis .
Background
Overview
Definition
Renal artery stenosis is the narrowing of one or both renal arteries, leading to decreased blood flow to the kidneys.
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Pathophysiology
The most common causes of renal artery stenosis are atherosclerosis and FMD, accounting for approximately 90% and 10% of renal artery stenosis cases, respectively. Renal artery stenosis decreases renal perfusion, triggering the RAAS, which leads to renovascular hypertension and may cause ischemic nephropathy, resulting in progressive renal dysfunction.
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Epidemiology
The prevalence of renal artery stenosis in the general population is estimated at 5-10%, and as high as 25% in elderly patients with hypertension.
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Risk factors
Risk factors for renal atherosclerosis include older age, diabetes mellitus, dyslipidemia, tobacco use, PAD, and a family history of CVD. Risk factors for FMD include female sex, tobacco use, and a family history of FMD.
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Disease course
Clinically, renal artery stenosis can present with refractory hypertension, impaired renal function, pulmonary edema, and congestive HF. Physical examination may reveal an abdominal bruit.
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Prognosis and risk of recurrence
The prognosis of renal artery stenosis can be severe if left untreated, potentially leading to CKD or ESRD. Patients undergoing revascularization for hypertension related to atherosclerotic stenosis should continue pharmacotherapy after the procedure to prevent renal and cardiovascular events. Restenosis occurs in 10-25% of cases.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of renal artery stenosis are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2024), the European Society of Cardiology (ESC 2024), the Japanese Society of Nephrology (JSN 2019), the American College of Preventive Medicine (ACPM/PCNA/ABC/ASPC/ASH/AAPA/AGS/AHA/NMA/ACC/APhA 2018), the Canadian Hypertension Education Program (CHEP 2018), ...
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