Use of Renin-Angiotensin System Blockade in Patients with Renal Artery Stenosis

Cohen, Jordana B.; Townsend, Raymond R.

doi:10.2215/cjn.04240414

Cited by 3 publications

(1 citation statement)

References 48 publications

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“…Physician scientist, Goldblatt conducted foundational animal experiments investigating the effect of unilateral and bilateral renal artery stenosis on systemic blood pressure. 21,22 Restricting blood flow to one kidney with a functioning contralateral kidney resulted in upregulation of the neurohormonal pathway of RAAS. The affected juxtaglomerular apparatus of the nephron senses the low flow state and releases renin.…”

Section: Pathophysiologymentioning

confidence: 99%

<p>Renal Artery Stenosis in the Patient with Hypertension: Prevalence, Impact and Management</p>

Manaktala

Soto

White

2020

IBPC

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Atherosclerosis is the primary cause of renal artery stenosis. Atherosclerotic renal artery stenosis (ARAS) is associated with three clinical problems: renovascular hypertension, ischemic nephropathy and cardiac destabilization syndrome which pose huge healthcare implications. There is a significant rate of natural disease progression with worsening severity of renal artery stenosis when renal revascularization is not pursued in a timely manner. Selective subgroups of individuals with ARAS have had good outcomes after percutaneous renal artery stenting (PTRAS). For example, individuals that underwent PTRAS and had improved renal function were reported to have a 45% survival advantage compared to those without improvement in their renal function. Advances in the imaging tools have allowed for better anatomic and physiologic measurements of ARAS. Measuring translesional hemodynamic gradients has allowed for accurate assessment of ARAS severity. Renal revascularization with PTRAS provides a survival advantage in individuals with significant hemodynamic renal artery stenosis lesions. It is important that we screen, diagnosis, intervene with invasive and medical treatments appropriately in these high-risk patients.

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Section: Pathophysiologymentioning

confidence: 99%

<p>Renal Artery Stenosis in the Patient with Hypertension: Prevalence, Impact and Management</p>

Manaktala

Soto

White

2020

IBPC

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Renal Artery Reconstruction for Refractory Hypertension Caused by Congenital Renal Artery Deficiency

Dong

Pan

et al. 2021

Annals of Vascular Surgery

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Atherosclerotic renal artery stenosis and revascularization

Choi

2014

Expert Review of Cardiovascular Therapy

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Atherosclerotic renovascular disease is the most common cause of secondary hypertension. The patients with renovascular disease are at increased risk for adverse cardiac outcomes. Recent trials comparing medical therapy alone to medical therapy with stenting are flawed, but lay to rest any existing debate that unselected revascularization is unwarranted; however, revascularization may be appropriate in high-risk populations. Defining an appropriate population for revascularization is an area of ongoing study. Furthermore, delivery of optimal medical therapy in this population is inadequate. This review describes recent developments in renal artery revascularization.

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Use of Renin-Angiotensin System Blockade in Patients with Renal Artery Stenosis

Cited by 3 publications

References 48 publications

<p>Renal Artery Stenosis in the Patient with Hypertension: Prevalence, Impact and Management</p>

<p>Renal Artery Stenosis in the Patient with Hypertension: Prevalence, Impact and Management</p>

Renal Artery Reconstruction for Refractory Hypertension Caused by Congenital Renal Artery Deficiency

Atherosclerotic renal artery stenosis and revascularization

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