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Renal Vascular Disease

Renal vascular disease affects the blood flow of the kidneys. It affects the arteries and veins of the kidney which carry blood in and out of the kidney. It can lead to kidney damage, kidney failure,hypertension and high blood pressure.

Different vascular conditions are

  • Renal artery stenosis (RAS): In this there is an artery to the kidney becoming narrow and blocked. This can lead to high blood pressure and kidney failure. People who smoke are at a higher risk of developing this disease. It’s mostly seen in older men between 50 and 70 ages. Risk factors for RAS are High cholesterol, diabetes, overweight, and family history of heart disease . High blood pressure can cause RAS or can be a result of RAS.
  • Renal artery thrombosis: It occurs due to formation of a blood clot in an artery that carries blood to the kidney. This can lead to blockage of blood flow and result in kidney failure
  • Renal vein thrombosis: It occurs due to formation of a clot in a vein to the kidney.
  • Renal artery aneurysm: It is a bulging or enlargement of a weak area in the wall of an artery to the kidney. Aneurysms  are usually small and do not  cause any symptoms until ruptured. They occur rarely and are mostly found during screening for other conditions.
  • Atheroembolic renal disease: It is caused when a clot or plaque breaks off from a larger artery and travels through the blood to the kidney. This clot blocks small renal arteries. This is a common cause of renal diseases in older people.

High blood pressure can be caused due to an increase in production of a hormone called renin. Kidneys produce more renin when their blood flow decreases.

What causes renal vascular disease?

Renal vascular disease can be caused by various factors depending on the specific condition involved. The primary causes are:

  • Atherosclerosis
  • Injury
  • Infection
  • Birth defect
  • Surgery
  • Pregnancy
  • tumors
  • Aneurysm
  • Certain medicines
  • Other underlying conditions

Who is at risk for renal vascular disease?

 Various Risk factors for renal vascular disease are:

  • Older people
  • High cholesterol
  • Females more than males
  • Diabetes
  • Atherosclerosis
  • High blood pressure
  • Smoking

What are the symptoms of renal vascular disease?

According to the type of disease and amount of damage caused, renal vascular disease show various symptoms

Renal Artery Stenosis

  • When 3 or more medicines are not sufficient to control blood pressure
  • Increased levels of  urea in the blood. Urea is a waste product made by the kidneys
  • kidney failure which cant be explained.
  • taking an angiotensin-converting enzyme (ACE) inhibitor for blood pressure and/or heart treatment for the first time can result in sudden kidney failure.

Renal Artery Thrombosis

  • pain of sudden origin between the ribs and the upper border of the hip bone known as flank pain, pain and tenderness
  • FeverBlood in the urine
  • Nausea and vomiting
  • Sudden decrease in kidney function
  • High blood pressure

A small clot may go undetected and do not cause any symptoms

Renal Artery Aneurysm

  • symptoms are often not present
  • High blood pressure
  • aneurysms can rupture and may cause flank pain and blood can be present in urine

Atheroembolic Renal Disease

  • Skin lesions or red or purple color of the skin.
  • Kidney failure
  • areas of discoloration on the toes and feet
  • Stomach  pain
  • Fever
  • Confusion
  • Weight loss
  • Diarrhea
  • Muscle pain

Renal Vein Thrombosis

When the onset is slow 

  • typically causes no symptoms

In case of Sudden Onset

  • continuous flank pain with spasms 
  • pain between the ribs and the backbone
  • Blood in urine
  • kidney function decreased

Renal vascular disease symptoms can be confused with other medical conditions or problems. Consult  with your healthcare provider for a definitive diagnosis.

How is renal vascular disease diagnosed?

Review of your medical history and physical examination can help in diagnosis. Other tests that can be used are :

  • Arteriogram or angiogram. It is an X-ray image used to check for aneurysm, narrowing, or blockages in blood vessels. A dye (contrast) is injected through a thin and flexible tube which is  placed in an artery. Dye helps in making the blood vessels visible on X-ray.
  • Duplex ultrasound. This test is performed to check blood flow and the structure of the renal veins and arteries. in this  2 modes of ultrasound are used, hence the term duplex. The first ultrasound is used to take an image of the affected renal artery . Blood flow is checked with the help of second mode.
  • It is performed to check the structure and function of the kidneys. It is a type of nuclear radiology procedure. In this a tiny amount of a radioactive substance is used which  helps view the kidneys. Therefore it is also called a nuclear radiology procedure.
  • Magnetic resonance angiography (MRA). This test is a combination of intravenous (IV) contrast dye and magnetic resonance imaging (MRI) technology to see blood vessels. Contrast dye helps see the blood vessels which appear solid on the MRI image. 

What is the treatment for renal vascular disease?

Various factors are taken into consideration before making a treatment plan. 

These factors are:

  • Age of the patient
  • Medical history
  • overall health 
  • Present state of illness
  • Ability of patients to handle specific therapies, procedures and mediciences.
  • Treatment preference of patient

different type of renal vascular disease requires different treatment.

Renal Artery Stenosis

Medical Treatment

  • Treatment of  high blood pressure using blood pressure lowering medicines other than ACE inhibitors
  • for atherosclerosis,medicines to lower cholesterol may be given
  • Treatment of  medical conditions such as diabetes is done 

Surgical Treatment

  • Various Endovascular procedures like angioplasty or placement of stent.  In angioplasty opening of a renal artery is done using a balloon or other method. In stent  placement a tiny, expandable metal  coil is placed inside an artery to keep the artery open.
  • Open surgery can be done to bypass the blocked renal artery.

Renal Artery Thrombosis

thrombolytic (clot-dissolving) medicine may be infused into the renal artery for several hours to several days to break up the clot in case of acute cases of disease.

In some cases surgery can also be done to remove the clot or to bypass the artery.

Renal Artery Aneurysm

Renal artery aneurysm treatment depends on size and symptoms of the aneurysm. smaller aneurysms can be left untreated and are watched for growth or problems. for larger, tearing, or growing aneurysms surgical treatment can be done. surgery can be performed  for aneurysms which  cause lack of blood flow to the kidney and high blood pressure.

a renal artery aneurysm in a pregnant woman or a woman of childbearing age, treatment of choice is usually surgery because of the increased risk for rupture (bursting)

Atheroembolic Renal Disease

To lower cholesterol, blood pressure, and treat other related conditions, such as diabetes treatment may include medicines

Diet and exercise are advised in order to lower blood pressure. foods rich in fats and salt should be avoided.

Surgical treatment may include:

  • Endovascular procedures such as angioplasty where the opening of a renal artery is done using a balloon or other method or placement of a stent which is a expandable tiny metal coil placed inside an artery to keep the artery open.
  • Open surgery can be done to bypass the blocked renal artery.

Renal Vein Thrombosis

Treatment of choice is generally an anticoagulant which helps in preventing the blood from clotting. They can be given intravenously (IV) for several days, and  then given orally for a few weeks.

What are the complications of renal vascular disease?

Renal vascular disease can lead to kidney failure.dialysis or a kidney transplant may be required. Other complications include:

  • Heart attack
  • Heart disease
  • Damage to blood vessels
  • Loss of vision
  • Heart failure
  • Stroke

When should I call my healthcare provider?

In case of new symptoms or you feel your symptoms are getting worse, consult your doctor.

Key points about renal vascular disease

  • Renal vascular disorders are a variety of conditions affecting the blood flow into or out of the kidneys.
  • Thus affecting the function of the kidneys. It  should be treated immediately in order  to prevent permanent damage or further complications.