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Renal Vascular Disease

What is 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.

Types of renal vascular disease are:

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. High cholesterol, high triglycerides, diabetes, excess weight, and 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 a kidney. It may block blood flow and cause kidney failure.
Renal vein thrombosis. This is the formation of a clot in a vein to a kidney.
Renal artery aneurysm. This is a bulging, weak area in the wall of an artery to a 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 a kidney 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.
Diabetes.
Hypertension.
Morbid obesity.
Fibromuscular dysplasia.
Injury.
Infection.
Inflammatory or other underlying disease.
Surgery.
Tumors.
Aneurysms.
Pregnancy.
Certain medicines.
Birth defects.

Who is at risk for renal vascular disease?

Risk factors for renal vascular disease include:

Older age.
Being biologically female.
Atherosclerosis.
High blood pressure, especially new high blood pressure in an older person.
Smoking.
High cholesterol.
Diabetes.

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.

Type of renal vascular disease	Symptoms
Renal artery stenosis	High blood pressure that doesn’t get better with 3 or more medicines Increased urea (a waste product made by the kidneys) in the blood Unexplained kidney failure Sudden kidney failure when first taking an angiotensin-converting enzyme (ACE) inhibitor to treat high blood pressure or heart conditions
Renal artery thrombosis	Sudden onset of side pain between the ribs and the upper border of the hip bone (flank pain), pain, and soreness Fever Blood in the urine Nausea and vomiting Sudden decrease in kidney function High blood pressure A gradual or incomplete clot may not cause symptoms and go undetected.
Renal artery aneurysm	Often no symptoms High blood pressure Flank pain and blood in the urine if there is a tear in the aneurysm
Atheroembolic renal disease	Skin lesions or a reddish or purplish color of the skin Discolored areas of the toes and feet Kidney failure Belly pain Diarrhea Nausea, vomiting Confusion Weight loss Fever Muscle aches
Renal vein thrombosis	Slow onset: Most often no symptoms Sudden onset: Ongoing severe flank pain with spasms at times Soreness over the kidney, between the ribs and the backbone Decreased kidney function Blood in the urine

These symptoms may be caused by other health problems. Always talk with your doctor for a diagnosis.

How is renal vascular disease diagnosed?

Your doctor will review your health history and do a physical exam. You may also need these tests:

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 two 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 medicine 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 fields and radio waves along with intravenous (I.V.) contrast dye to see blood vessels. Contrast dye causes blood vessels to appear solid on the MRI image. This lets the doctor see the blood vessels and how the blood flows through them.

How is renal vascular disease treated?

Treatment will depend on your symptoms, age, general health, and on how severe the condition is.

Treatment will also vary depending on the type of renal vascular disease that you have.

Type of renal vascular disease	Treatment
Renal artery stenosis	Medical treatment: Blood pressure lowering medicines to treat high blood pressure Medicines to lower cholesterol for atherosclerosis Treatment of related health 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 carefully 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 bursting (rupture), a renal artery aneurysm during pregnancy or during the childbearing years 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 changes, including not eating foods high in fat and salt, and exercise are urged to lower blood pressure. 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. Anticoagulants may be given by I.V. for several days, then given by mouth for a few weeks or more.

What are possible complications of renal vascular disease?

In time, renal vascular disease can lead to kidney failure. This may require dialysis or a kidney transplant. Other complications include:

Heart disease.
Stroke.
Heart attack.
Heart failure.
Damage to blood vessels.
Vision loss.

When should you contact your doctor?

If your symptoms get worse or you have new symptoms, tell your doctor.

Key points about renal vascular disease

Renal vascular disorders include a variety of conditions affecting the blood flow into or out of the kidneys.
Risk factors include being older, being biologically female, smoking, and having high blood pressure or diabetes.
Conditions that affect the blood flow through the kidneys can affect how well the kidneys work.
Complications can include heart disease, stroke, heart attack, and vision loss. Over time it can lead to kidney failure.
Treatment varies depending on the type of renal vascular disease you have.

Next steps

Tips to help you get the most from a visit to your doctor:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your doctor tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your doctor gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your doctor if you have questions.