Renal Artery Stenosis

Treatment

Without treatment, renal artery stenosis (RAS) may cause high blood pressure, eventually leading to kidney failure. Kidney failure has numerous causes, but the most common are uncontrolled blood pressure and diabetes. Most often, these conditions lead to a progressive decline in kidney function until the kidneys can no longer filter the blood properly. At that point, you would need a kidney transplant or regular dialysis, which entails using a machine to clear your blood of the toxins/waste products the body produces daily.

Although RAS can’t be cured, treatment options are available to help prevent or slow the development of the disease. Your doctor will consider the full spectrum of options—including lifestyle changes, medications, and medical procedures—in deciding what’s best for you. The type of treatment you receive, as with cardiovascular disease in general, depends on your circumstances, the extent of disability and risk, and the nature of the problem. Similarly, the earlier your RAS is diagnosed and the sooner your treatment begins, the better your prospects for slowing its progress will be sooner your treatment begins, the better your prospects for slowing its progress.

Lifestyle changes

Some patients may be at the beginning stages of RAS. In these cases, changing lifestyle elements such as diet and exercise might be enough to get you back on track for good health and help slow or reverse the progress of your condition. Your doctor will likely recommend that you make the following lifestyle changes:

• Eat a healthy diet – A heart-healthy diet is rich in fruits, vegetables, whole grains, and limited in salt and saturated fats. Your doctor may suggest working with a dietician or nutritionist to develop an eating plan.

• Exercise regularly – Getting regular exercise is one of the keys to heart health. Most doctors recommend incorporating more movement into daily life, such as taking the stairs rather than an elevator or escalator. Be sure to check with your doctor before embarking on any exercise plan.

• Quit smoking – Tobacco use is one of the leading causes of heart health problems. If you don’t smoke, don’t start. If you do smoke, now’s the time to quit. Your doctor is a great resource you can use to help you succeed.

• Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) – Motrin, Aleve, Advil, naproxen, high-dose aspirin (>325 mg daily), etc., can damage the kidney permanently.

• Learn about your risk factors – It’s important to know your risk factors associated with RAS, such as high blood pressure, high cholesterol, and diabetes, so that you can work with your doctor to help manage them.

Medications

In addition to making lifestyle changes, most doctors will prescribe certain medications as the first line of treatment for your RAS. These medications will help manage the following risk factors for RAS and to slow the progression of the disease:

• Blood pressure (hypertension) – High blood pressure can be caused by blockages in the arteries to the kidneys and can also be a risk factor for developing RAS and heart attack, stroke, kidney disease, and eye problems. Taking medications to help lower and control your blood pressure can prevent or delay the development of RAS and other health problems.
• Cholesterol – If you have RAS, you can reduce your risk of heart attack or stroke by controlling your cholesterol level. Your doctor may prescribe medications to lower your cholesterol levels to prevent additional buildup of plaque.
• Diabetes – Diabetes is becoming the most common—and a serious—risk factor for RAS. If you have diabetes, your risk of also developing RAS is higher than for people who don’t have diabetes. If you have both RAS and diabetes, your risk for high blood pressure, kidney failure, heart attack, or stroke is much higher than for people who only have RAS. Managing your diabetes can help slow the progression of your RAS.
• Atherosclerosis – RAS results from atherosclerosis, or arterial plaque buildup, which can cause artery blockages. Given this is the same process that occurs in other vascular areas, such as the heart and the carotid arteries, managing your medications for atherosclerosis will also help slow the progression of your RAS.

Procedures

Suppose you have RAS that's not improving with lifestyle changes and medications. In that case, your doctor may recommend revascularization procedures to re-establish blood flow through your narrowed or blocked kidney arteries, which results in improved kidney function and possibly lower blood pressure. After treatment of a kidney artery, you may still have high blood pressure, but you may need less medication to control it.

• Endovascular procedures – An endovascular procedure is performed inside the blood vessels using a small, flexible tube called a catheter. Your doctor may recommend renal artery angioplasty and stenting. This procedure has been used for decades to treat blocked arteries in the heart to restore blood flow and prevent or stop chest pain and heart attack. For patients with fibromuscular dysplasia (FMD), balloon angioplasty alone is usually highly effective.
• Surgical procedures – The following are the two surgical procedures used to treat RAS and are rarely ever performed:
  • Endarterectomy – This surgery involves a surgeon removing the inner lining of the renal artery and the plaque causing the blockage.
  • Bypass surgery – This surgery involves a surgeon creating a detour (bypass) around the portion of the artery that’s blocked or narrowed.