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, too much 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

  • 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 sex

  • 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 tenderness

  • 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 a tear in the aneurysm

Atheroembolic renal disease

  • Skin lesions or red or purple 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:

  • On-going severe flank pain with spasms at times

  • Soreness over the kidney, between the ribs and the backbone

  • Decreased kidney function

  • Blood in urine    

These symptoms may look like other health 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. 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 to make the blood vessels visible on an 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 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 (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 and how the blood flows through them.

How is renal vascular disease treated?

Your healthcare provider will figure out the best treatment for you based on:

  • How old you are

  • Your overall health and medical history

  • How sick you are

  • How well you can handle specific medicines, procedures or therapies

  • How long the condition is expected to last

  • Your opinion or preference

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:

  • Blood pressure lowering medicines to treat high blood pressure

  • Medicines to lower cholesterol 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 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 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 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. They may be given intravenously (IV) 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

  • Loss of vision