Renovascular disease. (February 2023)

• Record Type: Journal Article
• Authors: Vassallo, Diana; Kalra, Philip A.
• Is Part Of: Medicine. Volume 51:Number 2(2023)
• Page Start: 138
• Page End: 143
• Publication Date: 2023-02
• Subjects: ASTRAL trial -- atherosclerotic renovascular disease -- chronic kidney disease -- fibromuscular disease -- hypertension -- MRCP -- renal artery stenosis -- renal revascularization; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Médecine factuelle -- Périodiques; Medicine; Periodicals; Electronic journals; Electronic journals; 610
• DOI: 10.1016/j.mpmed.2022.11.007
• Languages: English
• ISSNs: 1357-3039

Abstract

Abstract: In populations in developed countries fibromuscular disease accounts for around 10% of all cases of renal artery stenosis (RAS), usually presenting as hypertension in young people, most often women. Atherosclerotic renovascular disease (ARVD) accounts for the remaining 90% of cases. ARVD is a disease of ageing, frequently associated with hypertension and renal dysfunction. It is commonly accompanied by major atherosclerotic vascular disease in other parts of the body, such as coronary artery disease, peripheral vascular disease, cerebrovascular disease and aortic aneurysms. Clinical presentations include hypertension, chronic or acute kidney disease and heart failure, although many patients with ARVD are identified incidentally during screening for extra-renal vascular disease. The mainstay of treatment involves general vascular protection centred on adequate blood pressure control, antiplatelet agents, renin–angiotensin blockade and statin therapy; however, a minority of patients gain benefit from percutaneous renal artery angioplasty and stenting. Two large prospective randomized controlled trials (ASTRAL, CORAL) have failed to show an overall benefit of intervention over optimal medical therapy in trial settings, but higher risk patients contributed only a small proportion of participants. However, observational evidence suggests that revascularization can improve the outcomes of patients with high-risk phenotypes such as flash pulmonary oedema, rapidly deteriorating renal function or uncontrolled hypertension. Future research is needed to help identify patients who will benefit from revascularization, while avoiding this procedure and its attendant risks in others.