Diagnosis of renal vascular disease

Abstract

Renal vascular disease is a common cause of diastolic hypertension. Most frequently renal arterial constriction is produced by atherosclerosis, usually localized in the proximal segment of the artery. Other forms of renal arterial stenosis include fibromuscular intimal and medial hyperplasia, as commonly observed in young patients, and renal arterial aneurysms. In general, the aim in selection of cases for renovascular study is delineation of those patients with severe diastolic hypertension who would make appropriate surgical candidates should a renovascular lesion be disclosed. The excretory pyelogram is a poor screening procedure since at least 30 per cent of patients with proved renal artery stenosis demonstrate no abnormality with this study. Radioisotope renography is simple and discloses some derangement in 90 per cent of patients with renovascular hypertension. Split function study with ureteral catheterization is an accurate screening procedure for main renal arterial stenosis but is cumbersome and not infrequently followed by urinary tract infections. Renal arteriography with direct introduction of contrast material into the aorta by catheter or needle constitutes the most significant element in evaluation of patients with possible renal vascular disease.