Renovascular disease natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Complications

• Renovascular hypertension
• Ischemic Nephropathy
• Accelerated CV Disease
• Congestive Heart Failure
• Stroke
• Secondary Aldosteronism

Prognosis

Favorable Predictors

Successful Outcome For Control Of Hypertension

• Rapid acceleration of hypertension over the prior weeks or months
• Presence of “malignant” hypertension
• Hypertension in association with flash pulmonary edema
• Contemporaneous rise in serum creatinine
• Development of azotemia in response to ACE inhibitors administered for control of hypertension.

Successful Salvage Or Preservation Of Renal Function

• Recent rapid rise in creatinine, unexplained by other factors
• Azotemia resulting from ACE inhibitors
• Absence of diabetes or other cause of intrinsic kidney disease
• Presence of global renal ischemia, wherein the entire functioning renal mass is subtended by bilateral critically narrowed renal arteries or a vessel supplying a solitary kidney.

Unfavorable Predictors

• Renal atrophy demonstrated by kidney length <7.5 cm on ultrasound
• High renal resistance index detected by duplex ultrasound
• Proteinuria > 1gm/day
• Hyperuricemia
• Creatinine clearance <40 mL/minute

References

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