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Renal Artery Stenosis

Atherosclerotic and Fibromuscular Narrowing of the Renal Artery

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Renal Artery Stenosis?

Renal artery stenosis is narrowing of one or both renal arteries, most commonly from atherosclerosis (80-90%) or fibromuscular dysplasia (10-15%).

Hemodynamically significant stenosis (>60-70% narrowing) reduces renal perfusion, stimulates renin release, and contributes to secondary hypertension and ischemic nephropathy.

Clinical suspicion arises from resistant hypertension, abrupt pulmonary edema, or bilateral disease with acute creatinine rise after ACEi/ARB.

Diagnosis uses duplex ultrasound, CT angiography, or MR angiography; catheter angiography remains gold standard and enables intervention.

Symptoms

Severe, resistant, or accelerated hypertension
Abdominal or flank bruits on auscultation
Unexplained rise in serum creatinine, particularly after ACEi/ARB initiation
Recurrent flash pulmonary edema (Pickering syndrome)
Asymmetric kidney size on imaging
Peripheral vascular disease or coronary artery disease often coexist

Risk Factors

Atherosclerotic risk factors: diabetes, hypertension, smoking, dyslipidemia, older age
Known atherosclerosis in other vascular beds (CAD, PAD, cerebrovascular)
Female sex under 50 and family history (fibromuscular dysplasia)
Chronic kidney disease with resistant hypertension
Recurrent pulmonary edema with preserved ejection fraction
Trauma, inflammatory arteritis (Takayasu), or radiation

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Resistant hypertension requiring three or more medications
  • Abrupt rise in creatinine after starting ACEi or ARB
  • Recurrent flash pulmonary edema without clear cardiac cause

Treatment Methods

01
Atherosclerotic RAS: medical therapy with RAS blockade (carefully), blood pressure control, statin, antiplatelet, smoking cessation
02
Revascularization (percutaneous angioplasty with stenting) for refractory HTN, progressive CKD, or recurrent flash pulmonary edema despite optimal medical therapy
03
Fibromuscular dysplasia: percutaneous transluminal angioplasty (without stent) as first-line intervention
04
Control cardiovascular risk factors: lipid management, diabetes control, weight optimization
05
Surveillance imaging after intervention to monitor restenosis
06
Consider specialty evaluation for atypical features or young patients for fibromuscular dysplasia workup

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.