Abstract
Renal artery stenosis is one common clinical problem. It has wide spectrum of pathophysiology with 3 most common clinical syndromes, ischemic nephropathy, hypertension, and cardiac destabilization syndrome. Aim: To date there was not any specific diagnostic criteria for renal artery stenosis. Method: Clinicians only used some clinical syndromes to guide the diagnostic possibility of renal artery stenosis. RADUS as one sensitive and specific diagnostic method, still had some disadvantages. Results: it gives false negative results in 10-20% of patients due to confounding factors such as operator capability, obesity, or abdominal gas distribution. CTA and MRA was excellent, but possessed some risks for the patient. Therefore, CTA was mostly recommended in patient with the planning of revascularization. Management of renal artery stenosis was still debated between optimal medical management and revascularization because the complexities of mechanisms underlying the renal artery stenosis. Because of the complicated pathophysiology of renal artery stenosis, revascularization could not entirely improve renovascular hypertension and nephropathy. Revascularization offered best results in fibromuscular dysplasia, although procedure related complication was still high. Revascularization, even though it might have high success rate in atherosclerotic renal artery stenosis, but the incidence of re-stenosis was also fairly high. Conclusion: Overall, revascularization was recommended in FMD, but should only be preserved for atherosclerotic renal artery stenosis after the failure of optimal medical management.
Highlights
Renal artery stenosis becomes a substantial clinical problem especially in countries with poor resources
Atherosclerotic renal artery stenosis was relatively common in population (6.8% in population >65 y.o) and the prevalence continues to increase with the increase of age
More than 50% atherosclerotic renal artery stenosis will worsen in 5 years if it leaved without any treatment.[2,4]
Summary
Renal artery stenosis becomes a substantial clinical problem especially in countries with poor resources. Some authors suggested clinical suspicion as a guide for diagnosing renal artery stenosis.[1,5] Renal artery duplex ultrasonography is recognized as a sensitive diagnostic method for renal artery stenosis, there are still many confounding factors It gave negative results in 10-20% of cases. Studies indicated renal artery revascularization did not improve patients’ outcomes in the aspects of renal function and cardiovascular outcomes.[7] Angioplasty and stenting procedures offered excellent results for fibromuscular dysplasia, but evidence was not enough to prove benefit for blood pressure control and renal function improvement Both procedures possessed high prevalent risks and did not provide any prevention from cardiovascular risk.[8,9] This review article explained about problems in the diagnosis and management of renal artery stenosis, especially in the setting of poor resources
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