Renal artery stenosis causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Renal artery stenosis is most commonly caused by development of atherosclerotic plaque in the renal arteries (termed atherosclerotic renal artery stenosis). Less frequently, it is caused by fibromuscular dysplasia.
Causes
Unilateral renal artery stenosis has two major causes:
1) Atherosclerosis: Most common cause seen in almost 60-90 percent of the cases associated with renal artery stenosis. Atherosclerosis mostly affects men over the age of 45 years and mainly involves the proximal part of the main renal artery. Although this condition is also commonly seen as an isolated lesion even in patients not having the underlying atherosclerotic disease. The risk factors associated with atherosclerosis are Dyslipidemia, cigarette smoking, virus infection, immune damage, and elevated concentrations of homocysteine.
2)Fibromuscular dysplasia: This is responsible for causing renal artery stenosis in the remaining 30-30 percent of cases. In contrast to atherosclerosis, fibromuscular dysplasia most often affects women younger than the age of 50 years and typically involves the middle and distal main renal artery or the intrarenal branches. Other less common causes (less than 10%) include thromboembolic disease, arterial dissection, infrarenal aortic aneurysm, vasculitis (Takayasu arteritis, Buerger disease, polyarteritis nodosa, post radiation), neurofibromatosis type 1, retroperitoneal fibrosis.
Renal artery stenosis commonly results from atherosclerosis or fibromuscular dysplasia.
Atherosclerotic Renal Artery Stenosis
In atherosclerotic RAS, patients typically present with a progressive worsening of preexisting hypertension, often with a modest increase in serum creatinine. It is featured by an accelerated rise in systolic blood pressure, accompanying target-organ damage, and decline of renal function during antihypertensive therapy. ARAS is sometimes heralded by crescendo angina, resistant congestive heart failure, or flash pulmonary edema.
Fibromuscular Dysplasia
Fibromuscular dysplasia commonly affects mid-portions of the renal artery in younger individuals and rarely leads to major loss of renal function, although some progression may be seen, particularly in smokers. Fibromuscular dysplasia lesions appear most often as hypertension of early-onset and unusual severity. Occasionally, it presents as hypertension during pregnancy.