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Atherosclerotic renal artery stenosis--diagnosis and treatment

David Lao1, Punit S Parasher, Kerry C Cho

  • 1Division of Cardiology, University of California San Francisco, San Francisco, CA 94143-0103, USA.

Mayo Clinic Proceedings
|July 2, 2011
PubMed

Insights

Atherosclerotic renal artery stenosis (ARAS) treatment remains controversial. While medical management is standard, revascularization may benefit select patients with severe hypertension or declining kidney function.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Vascular Surgery

Background:

  • Renal artery stenosis (RAS) encompasses diverse conditions, with atherosclerotic RAS (ARAS) being most prevalent.
  • Current treatment guidelines for ARAS, particularly revascularization, are debated following recent clinical trials.
  • Intensive medical treatment is the consensus for all ARAS patients.

Purpose of the Study:

  • To review current understanding of ARAS, focusing on hypertension pathways and diagnostic/therapeutic options.
  • To evaluate the role and patient selection criteria for revascularization in ARAS.
  • To assess emerging tools for guiding revascularization decisions in ARAS.

Main Methods:

  • Literature search of PubMed using terms: renal artery stenosis, atherosclerotic renal artery stenosis, renal artery stenosis AND hypertension.
  • Analysis of recent publications on ARAS diagnosis and treatment.
  • Review of hypertension mechanisms, diagnostic modalities, and therapeutic strategies for ARAS.

Main Results:

  • Revascularization is not universally indicated for ARAS but is considered for specific patient groups.
  • Indications for revascularization include unstable angina, pulmonary edema, and significant ARAS with renal dysfunction or resistant hypertension.
  • The review analyzes diagnostic tools and therapies, assessing future decision-making algorithms.

Conclusions:

  • Optimal management of ARAS requires a tailored approach, balancing medical therapy with selective revascularization.
  • Further research and refined algorithms are needed to optimize patient selection for renal revascularization.
  • Understanding hypertension pathways is crucial for managing ARAS patients.

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