Renal Artery Stenosis Clinical Presentation

Updated: Jul 20, 2022
  • Author: Bruce S Spinowitz, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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History and Physical

Patients with ischemic renal vascular disease (RVD) present with one or more of the following clinical, historical, or diagnostic scenarios.

Because of the strong association of RVD with generalized atherosclerosis, many patients with RVD will have evidence of cerebrovascular, cardiovascular, or peripheral vascular disease  (eg, carotid bruits, history of transient ischemic attack or stroke).  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).

Sudden worsening of hypertension or kidney function may occur.  Acute kidney injury or decreased kidney function may occur after initiation of antihypertensive therapy, especially with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs); an increase in serum creatinine levels of more than 15% in this setting is strongly suggestive of RVD. 

Unexplained kidney 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 (so-called flash pulmonary edema).  Although flash pulmonary edema has been reported in patients with unilateral renal stenosis, it occurs more commonly in patients with bilateral renal stenosis. [6]