Cardiac Consequences of Renal Artery Stenosis

Renal artery stenosis (RAS) is most commonly caused by atherosclerotic disease. An alternative common etiology is fibromuscular dysplasia. RAS is present in up to 10% of elderly hypertensive patients, with overall prevalence between 0.5% and 5.5% in patients with chronic kidney disease. Patients with hemodynamically significant RAS have increased cardiovascular morbidity and mortality. Duplex ultrasonography (DUS), magnetic resonance angiography (MRA), computed tomographic angiography (CTA), and invasive angiography have all been used as diagnostic modalities for RAS detection. All patients with RAS should be on intensive medical therapy. Patients with RAS have a hyper reninemic state and despite common beliefs, angiotensin converting enzyme inhibitors (ACEi), and angiotensin receptor blockers (ARBs) are an important part of the therapeutic armamentarium, however they should be managed carefully. High intensity statin is crucial in all patients with atherosclerotic disease. Percutaneous revascularization is reasonable for patients with hemodynamically significant RAS and accelerated hypertension, malignant hypertension, and hypertension refractory to medical therapy. Patient with RAS treated with revascularization and stent placement should have close follow up to monitor their blood pressure, renal function and stent patency with DUS.