eMedicine Specialties > Nephrology > Hypertension and the Kidney

Renal Artery Stenosis: Follow-up

Author: Bruce S Spinowitz, MD, FACP, Clinical Professor of Medicine, Weill Medical College of Cornell University; School of Medicine; Associate Chairman, Associate Director and Attending Physician, Department of Medicine, Division of Nephrology, New York Hospital Medical Center Queens; Associate, Nephrology Associates, PC
Coauthor(s): Joanna Rodriguez, MD, Fellow, Department of Internal Medicine, Division of Nephrology, New York Hospital-Queens
Contributor Information and Disclosures

Updated: Jul 15, 2009

Follow-up

Further Outpatient Care

  • In view of the natural history of RVD, patients require serial determinations of serum creatinine levels, adequate blood pressure control, and serum potassium levels. Duplex ultrasound, if available, allows regular radiologic progression follow-up.

Prognosis

  • Researchers have studied the natural history of atherosclerotic renal artery stenosis by obtaining images from sequential abdominal aortographs or duplex ultrasound scans in patients with documented renal artery lesions who have been treated medically. Most studies show that progressive arterial obstruction occurs in 42-53% of patients with atherosclerotic renal artery stenosis, often within the first 2 years of radiographic follow-up. The incidence rate of progression to complete renal artery occlusion in these studies ranges from 9-16%; this often occurs in patients with a high-degree stenosis. In a study of 85 patients at the Cleveland Clinic who were followed for 3-172 months, patients with mild-to-moderate stenosis remained unchanged upon follow-up, and 39% of patients with greater than 75% lesions progressed to total occlusion.28

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • In many instances, patients have moderate-to-severe azotemia and the risks of contrast-induced ATN and atheroembolic renal failure are significant and could result in the need for permanent or temporary dialysis. These unfortunate outcomes must be discussed with the patient and put into perspective prior to any invasive procedures, such as surgery, angiography, or angioplasty.
 


More on Renal Artery Stenosis

Overview: Renal Artery Stenosis
Differential Diagnoses & Workup: Renal Artery Stenosis
Treatment & Medication: Renal Artery Stenosis
Follow-up: Renal Artery Stenosis
References
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Further Reading

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Keywords

renal artery stenosis, RAS, renovascular disease, ischemic nephropathy, atherosclerotic renovascular disease, renovascular hypertension, chronic renal insufficiency, end-stage renal disease, ESRD, atherosclerosis, ATH, RVD, renal artery occlusion, renal disease, kidney disease, ischemic renal disease, renal artery lesions

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Contributor Information and Disclosures

Author

Bruce S Spinowitz, MD, FACP, Clinical Professor of Medicine, Weill Medical College of Cornell University; School of Medicine; Associate Chairman, Associate Director and Attending Physician, Department of Medicine, Division of Nephrology, New York Hospital Medical Center Queens; Associate, Nephrology Associates, PC
Bruce S Spinowitz, MD, FACP is a member of the following medical societies: American College of Physicians, American Society of Nephrology, International Society for Peritoneal Dialysis, International Society of Nephrology, and Renal Physicians Association
Disclosure: AMAG Pharmaceuticals Grant/research funds Independent contractor; Roche Grant/research funds Independent contractor; Amgen Grant/research funds Independent contractor; Affymax Grant/research funds Independent contractor; Ortho Biotech Grant/research funds Independent contractor

Coauthor(s)

Joanna Rodriguez, MD, Fellow, Department of Internal Medicine, Division of Nephrology, New York Hospital-Queens
Disclosure: Nothing to disclose.

Medical Editor

Donald A Feinfeld, MD, FACP, FASN, Consulting Staff, Division of Nephrology & Hypertension, Beth Israel Medical Center
Donald A Feinfeld, MD, FACP, FASN is a member of the following medical societies: American Academy of Clinical Toxicology, American Society of Hypertension, American Society of Nephrology, and National Kidney Foundation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eleanor Lederer, MD, Consulting Staff, Louisville VA Hospital; Professor of Medicine; Interim Chief of Nephrology; Director of Nephrology Training Program; Director, Metabolic Stone Clinic; Director of Outpatient Clinics, Kidney Disease Program, University of Louisville School of Medicine
Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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