Renal Artery Stenosis Clinical Presentation

Updated: Aug 05, 2016
  • Author: Bruce S Spinowitz, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Presentation

History

Patients with documented or possible renovascular hypertension may experience progressive azotemia as a consequence of the renal ischemia and/or the persistence of significant hypertension. Refractory hypertension (ie, poor control of blood pressure despite treatment with three or more antihypertensive agents) may occur.

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Physical

The strong association of renal vascular disease (RVD) with generalized atherosclerosis indicates that any typical findings associated with cerebrovascular (eg, carotid bruits, old cerebrovascular accident, transient ischemic attack), cardiovascular, or peripheral vascular disease occur frequently in patients with RVD. Abdominal bruits are highly specific for RVD when heard over the flank and are back-and-forth in nature (ie, present during both systole and diastole).

Patients with ischemic RVD present with one or more of the following clinical, historical, or diagnostic scenarios:

  • Azotemia occurs in patients with peripheral vascular occlusive disease, carotid or coronary artery disease, and other signs of atherosclerosis.
  • Sudden worsening of hypertension or renal function may occur.
  • Acute renal failure or decreased renal function after antihypertensive therapy, especially with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers, may occur; an increase in serum creatinine levels of more than 15% in this setting is strongly suggestive of a high incidence of RVD.
  • Unexplained renal insufficiency may develop in elderly patients.
  • Congestive heart failure may occur with poor control of hypertension and renal insufficiency in the absence of a significant decrease in ejection fraction (the so-called flash pulmonary edema).
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