Chapter

Atherosclerotic renovascular disease

P A Kalra and J D Firth

in Oxford Textbook of Medicine

Published on behalf of Oxford University Press

Published in print May 2010 | ISBN: 9780199204854
Published online May 2011 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.211009_update_001
Atherosclerotic renovascular disease

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Atherosclerotic renovascular disease (ARVD), a general term that describes atheromatous narrowing of one or both renal arteries, affects about 0.5% of people over the age of 67 years in the United States of America. Patients with this condition are at high cardiovascular risk because of the presence of concomitant non-renal arterial disease, with mortality between 8 and 9% per year. Many patients have chronic kidney disease, but after the diagnosis of ARVD this only deteriorates in the minority, suggesting that prior hypertensive and/or ischaemic renal parenchymal injury is the usual cause of renal dysfunction.

Management—patients should be encouraged/helped to stop smoking and offered antiplatelet agents, cholesterol-lowering medication, blood pressure control (especially renin angiotensin blockade – which might appear surprising), and (in those with diabetes) optimization of glycaemic control. On the basis of randomized controlled trial data, they should not be offered revascularization by angioplasty/stenting for the purpose of improving blood pressure control or stabilizing/improving renal function, with reasonable exceptions to this being patients with otherwise unexplained rapid decline in renal function, recurrent episodes of flash pulmonary oedema, and (perhaps) those with severe hypertension not adequately controlled by drug treatment.

Chapter.  2038 words.  Illustrated.

Subjects: Nephrology

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