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 and high blood pressure.
Different vascular conditions which cause renal vascular disease-
- Renal artery stenosis (RAS): In this artery supplying the kidney becomes narrowed or blocked. High blood pressure and renal failure may result from this. Smokers have an increased chance of contracting this illness. It’s mostly seen in older men between 50 and 70 ages. Risk factors for RAS are High cholesterol, diabetes, overweight. High blood pressure can cause RAS or can be a result of RAS.
- Renal artery thrombosis: It happens when a blood clot forms in the artery that supplies blood to the kidney. This can lead to blockage of blood flow and result in kidney failure.
- Renal vein thrombosis: It develops as a result of clot development in a vein leading 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.
Renin is a hormone that is produced more often and has been linked to high blood pressure. 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
- Medication- Pain killers (NSAID)
Who is exposed to 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 signs or symptoms indicate renal vascular disease?
According to the type of disease and amount of damage caused, the renal vascular disease shows various symptoms:
Renal Artery Stenosis
- When three 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 can’t 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 is known as flank pain, pain and tenderness
- Fever
- Blood in the urine
- Nausea and vomiting
- A sudden decrease in kidney function
- High blood pressure
- A small clot may go undetected and 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
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 a renal vascular disease diagnosed?
A 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 aneurysms, narrowing, or blockages in blood vessels. A thin, flexible tube is inserted into an artery, and a dye (contrast) is administered through it. The dye helps in making the blood vessels visible on X-ray.
- Duplex Ultrasound: This examination is carried out to examine renal vein and artery anatomy and blood flow. In this, two 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 the second mode.
- Magnetic Resonance Angiography (MRA): This test is a combination of intravenous (IV) contrast dye and magnetic resonance imaging (MRI) technology to see blood vessels. The 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 medications.
- 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 the stent.
- In angioplasty opening of a renal artery is done using a balloon.
- To keep an artery open, a small, expandable metal is inserted within the artery during stent implantation.
- Open surgery can be done to bypass the blocked renal artery.
Renal Artery Thrombosis
A thrombolytic (clot-dissolving) medicine may be injected into the renal artery for several hours to several days in the event of acute cases of the disease in order to dissolve the clot.
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 the 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 a lack of blood flow to the kidney and high blood pressure.
The preferred course of therapy for a renal artery aneurysm in a pregnant or childbearing woman is often surgery due to the elevated risk of rupture (bursting).
Atheroembolic Renal Disease
Treatment is mostly conservative in the form of blood thinning medications (antiplatelets and anticoagulation) and hydration.
Renal Vein Thrombosis
Treatment of choice is generally an anticoagulant which helps in preventing the established blood clot from spreading.
What negative effects might renal vascular disease cause?
Kidney failure can be caused by renal vascular disease. There may be a need for dialysis or a kidney transplant. 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.
