Integrated Blood Pressure Control (Jun 2020)
Renal Artery Stenosis in the Patient with Hypertension: Prevalence, Impact and Management
Abstract
Rohini Manaktala, Jose D Tafur-Soto, Christopher J White Ochsner Clinic Foundation, Department of Cardiovascular Medicine, New Orleans, LA, USACorrespondence: Rohini ManaktalaOchsner Clinic Foundation, Department of Cardiovascular Medicine, 3rd Floor Atrium Tower, Room #3D718, 1514 Jefferson Highway, New Orleans, LA 70121, USATel +1 504-842-0879Fax +1 504-842-3278Email [email protected]: Atherosclerosis is the primary cause of renal artery stenosis. Atherosclerotic renal artery stenosis (ARAS) is associated with three clinical problems: renovascular hypertension, ischemic nephropathy and cardiac destabilization syndrome which pose huge healthcare implications. There is a significant rate of natural disease progression with worsening severity of renal artery stenosis when renal revascularization is not pursued in a timely manner. Selective sub-groups of individuals with ARAS have had good outcomes after percutaneous renal artery stenting (PTRAS). For example, individuals that underwent PTRAS and had improved renal function were reported to have a 45% survival advantage compared to those without improvement in their renal function. Advances in the imaging tools have allowed for better anatomic and physiologic measurements of ARAS. Measuring translesional hemodynamic gradients has allowed for accurate assessment of ARAS severity. Renal revascularization with PTRAS provides a survival advantage in individuals with significant hemodynamic renal artery stenosis lesions. It is important that we screen, diagnosis, intervene with invasive and medical treatments appropriately in these high-risk patients.Keywords: atherosclerotic renal artery stenosis, ARAS, percutaneous renal artery stenting, PTRAS, renin-angiotensin-aldosterone system, RAAS, acute decompensated heart failure, ADHF, chronic kidney disease, CKD, optimal medical therapy, OMT
