Renal artery stenosis

Abstract

Purpose Atherosclerotic renovascular disease remains highly prevalent and presents an array of clinical syndromes. Recent prospective trials have dampened enthusiasm for revascularization generally, but clinicians recognize the need to identify patients likely to benefit from vascular intervention. Recent findings highlight the inflammatory nature of vascular occlusive disease and the limits of the kidney to adapt to reduced blood flow. Although moderate reductions can be tolerated, severe impairment of renal perfusion leads to tissue hypoxia and activates inflammatory injury within the kidney. Hence, assessment of kidney viability and potential tools to modify mitochondrial and inflammatory damage may be important to identify patients for whom clinical intervention should be undertaken. Implications for practice Clinicians must recognize clinical syndromes that identify “high-risk” groups and apply revascularization in those likely to benefit. Future efforts to protect the kidney (e.g. mitochondrial protection) and/or cell-based therapy may amplify the clinical recovery when combined with restoring renal blood flow.

Evidence and Renovascular Disease: Trials and Mistrials?

“…11 Importantly, patients with atherosclerotic renal artery stenosis presenting with rapidly declining kidney function with bilateral atherosclerotic renal artery stenosis or stenosis to a solitary functioning kidney should be considered for revascularization to preserve kidney function. 12 …”

An Outline of Renal Artery Stenosis Pathophysiology—A Narrative Review

“…As with all forms of hypertension, the overall goal of managing RVH is to reduce the morbidity and mortality associated with elevated BP [ 20 ]. In patients with ARAS, invariably associated with systemic atherosclerosis, atherosclerotic risk factor must be controlled, and lifestyle modification must be implemented, including smoking cessation.…”

“…However, the modulation of the renin–angiotensin system in patients with RAS secondary to solitary functioning kidney or severe bilateral stenoses has the potential to dramatically decrease GFR and induce AKI and to reduce perfusion pressure so low as to induce ischemic nephropathy in pressure-dependent kidneys. Therefore, ACE inhibitors and sartans are contraindicated in those patients [ 20 ]. Some drawbacks of pharmacotherapy and the presence of patients with severe RAS refractory to the abovementioned hypotensive drugs were the impetus for the development of more permanent and decisive solutions such as surgical and percutaneous revascularization.…”

Comparison of the Effects of Mesenchymal Stem Cells with Their Extracellular Vesicles on the Treatment of Kidney Damage Induced by Chronic Renal Artery Stenosis

“…Chronic hypoxia is characterized by microvascular rarefaction leading to irreversible damage to the renal parenchyma. In fact, clinical studies have reported that even after resolution of stenosis through angioplasty, the recovery of renal function is limited, and patients often progress to end-stage chronic renal disease [ 5 – 8 ]. In addition, during unilateral renal stenosis, the contralateral kidney is constantly exposed to high blood pressure and exhibits structural and functional features of a hypertensive kidney.…”