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Utama > Renal > Management Of Renovascular Disease

Management Of Renovascular Disease

The management of renal artery stenosis (RAS) includes medical treatment, angioplasty, and surgery.

Medical management

Medical treatment of patients with Atherosclerotic RAS consists of the following measures:

  1. Use of cholesterol-lowering medication
  2. Low dose aspirin
  3. Cessation of smoking
  4. Medications to control  blood pressure and diabetes ( if present)

Recent studies have shown that medication without angioplasty (clinical procedure to dilate the narrowed segment of the blood vessel with a balloon) or surgical treatment is preferable for most patients with clinically stable renal artery stenosis1-2. More information is expected from the Cardiovascular Outcomes in Renal Atherosclerotic Lesions study (CORAL) which is currently in progress in the United States.3

Interventional /surgical management

Angioplasty with stenting is the usual first choice for vascular intervention. It is indicated in:

  • Flash pulmonary oedema which occurs as a result of sudden accumulation of fluids in the lungs
  • Rapidly deteriorating renal function especially if it leads to need of dialysis treatment
  • Resistant or severe hypertension
  • Fibromuscular dysplasia associated with hypertension/ high BP
  • Takayasu’s arteritis
  • Transplant renal artery stenosis

The decision regarding the need for vascular or surgical intervention is best guided by kidney specialists, and should take into account the local facilities and expertise available, the presence of other disease conditions, the severity of kidney disease and rate of progression of kidney disease.

References

  1. The ASTRAL Investigators. Revascularization versus medical therapy for renal artery stenosis. N Eng j Med 2009; 361:1953-62
  2. Bax L, Woittiez AJ, Kouwenberg HJ et al. Stent Placement in Patients with atherosclerotic renal artery stenosis and impaired renal function. Ann. Int.Med.2009;
    150:840-848
  3. Cooper CJ, Murphy TP, Matsumoto A, et al; Stent revascularization for the prevention of cardiovascular and renal events among patients with renal artery stenosis and systolic hypertension: rationale and design of the CORAL trial. Am Heart J. 2006 Jul; 152(1):59-66

 

Last Reviewed : 3 May 2016
Writer : Dr. Sunita Bavanandan
Accreditor : Y. Bhg. Datuk Dr. Ghazali bin Ahmad

 

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