What is Renal Vascular Disease

The providers at the Complex and Internal Medicine Clinic at CCH provide a number of services for patients with chronic medical conditions, including Renal Vascular Disease. Renal vascular disease affects the blood flow into and out of the kidneys. It may cause kidney damage, kidney failure, and high blood pressure.

Vascular conditions include:

• Renal artery stenosis (RAS). This is a narrowing or blockage of an artery to the kidneys. It may cause kidney failure and high blood pressure. Smokers have a greater risk of getting RAS. It’s most common in men between the ages of 50 and 70. High cholesterol, diabetes, being overweight, and having a family history of heart disease are also risk factors for RAS. High blood pressure is both a cause and a result of RAS.

• Renal artery thrombosis. This is a blood clot in an artery that supplies the kidney. It may block blood flow and cause kidney failure.

• Renal vein thrombosis. This is the formation of a clot in a vein to the kidney.

• Renal artery aneurysm. This is a bulging, weak area in the wall of an artery to the kidney. Most are small and don’t cause symptoms. Renal artery aneurysms are rare and are often found during tests for other conditions.

• Atheroembolic renal disease. This happens when a piece of plaque from a larger artery breaks off and travels through the blood. This blocks small renal arteries. This disease is becoming a common cause of kidney problems in older adults.

Renin is a strong hormone that raises blood pressure. Decreased blood flow to the kidney(s) from renal vascular disease may cause too much renin to be made. This can lead to high blood pressure.

What causes renal vascular disease?

The cause of renal vascular disease will depend on the specific condition involved. The main causes are:

• Atherosclerosis

• Injury

• Infection

• Inflammatory or other underlying diseases

• Surgery

• Tumor

• Aneurysm

• Pregnancy

• Certain medicines

• Birth defect

Who is at risk for renal vascular disease?

Risk factors for renal vascular disease include:

• Older age

• Female

• Atherosclerosis

• High blood pressure, especially new high blood pressure in an older person

• Smoking

• High cholesterol

• Diabetes

The symptoms of renal vascular disease may look like other medical conditions or problems. Always talk with your healthcare provider for a diagnosis.

How is renal vascular disease diagnosed?

Your healthcare provider will review your medical history and do a physical exam. Other tests may include:

• Arteriogram (or angiogram). This is an X-ray image of the blood vessels used to check for aneurysm, narrowing, or blockages. A dye (contrast) is injected through a thin, flexible tube placed in an artery. This dye makes the blood vessels visible on X-ray.

• Duplex ultrasound. This test is done to check blood flow and the structure of the renal veins and arteries. The term “duplex" refers to the fact that 2 modes of ultrasound are used. The first takes an image of the renal artery being studied. The second mode checks the blood flow.

• Renography. This test is used to check the function and structure of the kidneys. It is a type of nuclear radiology procedure. This means that a tiny amount of a radioactive substance is used during the test to help view the kidneys.

• Magnetic resonance angiography (MRA). This test uses a combination of magnetic resonance imaging (MRI) technology and intravenous (IV) contrast dye to see blood vessels. Contrast dye causes blood vessels to appear solid on the MRI image. This lets the healthcare provider see the blood vessels.

What is the treatment for renal vascular disease?

Your healthcare provider will figure out the best treatment for you based on many factors. Treatment will also vary depending on the type of renal vascular disease that is present.

Renal Artery Stenosis

Medical Treatment

• Blood pressure lowering medicines other than ACE inhibitors may be used to treat high blood pressure.

• Medicines to lower cholesterol may be prescribed for atherosclerosis.

• Treatment of related medical conditions such as diabetes.

Surgical Treatment

• Endovascular procedures such as angioplasty (the opening of a renal artery using a balloon or other method) or placement of a stent (a tiny, expandable metal coil placed inside an artery to keep the artery open).

• Open surgery to bypass the blocked renal artery.

Renal Artery Thrombosis

In acute cases, thrombolytic (clot-busting) medicine may be infused into the renal artery for several hours to several days to break up the clot.

Surgery to remove the clot or bypass the artery may be done in some situations.

Renal Artery Aneurysm

Treatment of a renal artery aneurysm depends on symptoms and the size and location of the aneurysm. Some smaller aneurysms may not be treated, but may be watched for growth or problems.

Surgery may be used to treat larger, tearing, or growing aneurysms. It may also be used for aneurysms causing lack of blood flow to the kidney and high blood pressure, and aneurysms causing symptoms.

Because of the increased risk for rupture (bursting), a renal artery aneurysm in a pregnant woman or a woman of childbearing age will generally be treated with surgery.

Atheroembolic Renal Disease

Treatment may include medicines to lower cholesterol, blood pressure, and treat other related conditions, such as diabetes.

Diet and exercise are urged to lower blood pressure. Avoid foods high in fats and salt.

Surgical treatment may include:

• Endovascular procedures such as angioplasty (the opening of a renal artery using a balloon or other method) or placement of a stent (a tiny, expandable metal coil placed inside an artery to keep the artery open).

• Open surgery to bypass the blocked renal artery.

Renal Vein Thrombosis

Renal vein thrombosis is generally treated with an anticoagulant, which keeps the blood from clotting. They may be given intravenously (IV) for several days, then given by mouth for a few weeks or more.

Disease management is not one-size-fits all and care should be individualized. Have you recently been diagnosed with Renal Vascular Disease? Do you have a loved one who needs assistance? Give the Complex and Internal Medicine team at Campbell County Health a call at 307-688-3535 for resources.