Robert Wood Johnson University Hospital
 

Renal Vascular Disease

Renal Vascular Disease

What is renal vascular disease?

Renal vascular disease is the name given to a variety of complications that affect the arteries and veins of the kidneys. These complications affect the blood circulation of the kidneys, and may cause damage to the tissues of the kidneys, kidney failure, and/or high blood pressure.

Vascular conditions affecting the renal arteries and veins include the following:

Renal vascular disease is often associated with hypertension (high blood pressure). Hormones which influence blood pressure are affected by kidney function. Decreased blood flow to the kidney(s) as a result of renal vascular disease may cause an excessive amount of renin to be produced. Renin is a powerful hormone that increases blood pressure.

What causes renal vascular disease?

Illustration of the anatomy of the kidney
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The cause of renal vascular disease will depend on the specific condition involved:

Risk factors for renal vascular disease include:

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking or diet, family history, or many other things. Different diseases have different risk factors.

Although these risk factors increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. Knowing your risk factors for any disease can help to guide you to the appropriate actions, including changing behaviors and being clinically monitored for the disease.

What are the symptoms of renal vascular disease?

Symptoms of renal vascular disease vary depending on the type of disease and degree of involvement present. Symptoms of various types of renal vascular disease include, but are not limited to, the following:

Type of Renal Vascular Disease Symptoms
Renal artery stenosis
  • Sudden onset of hypertension before age 50 suggests fibromuscular dysplasia-related stenosis.
  • Sudden onset of hypertension at or after age 50 suggests stenosis caused by atherosclerosis.
  • Hypertension not responsive to three or more blood pressure medications.
  • Increased urea (a waste product excreted by the kidneys) in the blood.
  • Unexplained kidney failure.
  • Sudden kidney failure when first taking an angiotensin-converting enzyme (ACE) inhibitor medication for blood pressure and/or heart treatment.

Renal artery thrombosis

Acute (sudden) complete blockage:

  • Sudden onset of flank (between the ribs and the upper border of the hip bone) pain and tenderness.
  • Fever.
  • Blood in the urine.
  • Nausea and/or vomiting.
  • Sudden decrease in kidney function.
  • Hypertension.

More gradual or incomplete blockages:

  • May be asymptomatic (without symptoms) and go undetected.
Renal artery aneurysm
  • Generally asymptomatic.
  • Hypertension may be present in up to 90 percent of persons with a renal artery aneurysm.
  • Dissecting aneurysms (caused by a tear in the inner layer of the artery wall) may cause flank pain and blood in the urine.
Atheroembolic renal disease
  • Skin lesions such as purpura (a type of rash in which blood cells leak into the skin or mucous membranes).
  • Mottling (discolored areas) of the toes and feet.
  • Kidney failure (either sudden or occurring over a longer period of time).
  • Abdominal pain.
  • Diarrhea.
  • Confusion.
  • Weight loss.
  • Fever.
  • Muscle aches.
Renal vein thrombosis

Chronic (over a period of time) onset:

  • Most often asymptomatic.

Acute (sudden) onset:

  • Persistent severe flank pain that may be spasmodic (with spasms) at times.
  • Soreness in the area over the kidney, between the ribs and the backbone.
  • Decreased kidney function.

The symptoms of renal vascular disease may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is renal vascular disease diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for renal vascular disease may include any, or a combination of, the following:

What is the treatment for renal vascular disease?

Specific treatment will be determined by your physician based on:

Treatment will also vary depending on the type of renal vascular disease that is present.

Type of Renal Vascular  Disease Treatment
Renal artery stenosis

Medical treatment:

  • Antihypertensive medications other than ACE inhibitors may be used to treat high blood pressure.
  • In stenosis caused by atherosclerosis, medications to lower cholesterol may be prescribed.
  • 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 surgical procedures to bypass the occluded renal artery. There are several variations of such procedures.
Renal artery thrombosis

Treatment of a renal artery thrombosis depends on the type (acute or chronic) of thrombosis, and the length of time since the thrombosis occurred.

In acute situations, thrombolytic ("clot-busting") medication 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 performed in some situations.

Renal artery aneurysm

Treatment of a renal artery aneurysm depends on factors such as the size and location of the aneurysm and whether or not symptoms are present. Certain types of small (less than two centimeters, or about three-quarters of an inch) aneurysms may not be treated, but may be observed for growth or development of other complications.

Larger aneurysms (greater than two centimeters, or three-quarters of an inch), dissecting aneurysms, aneurysms causing kidney ischemia (lack of blood flow to the kidney tissue) and hypertension, aneurysms that are growing larger, and aneurysms causing symptoms may be treated surgically.

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 surgically.

Atheroembolic renal disease

Treatment of atheroembolic renal disease depends on the extent of the disease and the individual situation.

Medical treatment may include medications to reduce cholesterol, blood pressure, and other related medical conditions, such as diabetes.

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 surgical procedures to bypass the occluded renal artery. There are several variations of such procedures.
Renal vein thrombosis Renal vein thrombosis is generally treated medically with anticoagulant (keeps the blood from clotting) medication. Anticoagulants may be given intravenously (IV) for several days, then given orally for several weeks up to an indefinite period of time.

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