Kidney non-tumor
Blood vessel disorders
Renal artery stenosis

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 27 December 2017, last major update December 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Blood vessel disorders renal artery stenosis [title]

Cite this page: Sangle, N. Renal artery stenosis. PathologyOutlines.com website. http://pathologyoutlines.com/topic/kidneyrenalartstenosis.html. Accessed January 18th, 2018.
Definition / general
  • Hypertension that responds to ACE inhibitors, with stenosis by intravenous pyelogram or renal scans, bruit, elevated renin
  • 2 - 5% of cases of hypertension, surgery curative in 70%
Causes
  • Atheromatous plaque: more common in older men with diabetes, often at orifice of renal artery and associated with aneurysmal dilatation of aorta distal to renal arteries
  • Fibromuscular dysplasia: more common in younger women; may involve other vessels; not responsive to hypertensive drugs; 50% bilateral, often involve distal 2/3 of renal artery; due to intimal, medial, perimedial or periarterial fibroplasia, medial hyperplasia or medial dissection
  • Radiation injury: loss of muscle, intense fibrosis in all wall layers; usually after radiation treatment, including renal artery field years previous
  • Takayasu’s aortitis: also called pulseless disease; chronic sclerosing aortitis of unknown etiology
Case reports
Treatment
Gross description
  • Shrunken kidney
Microscopic (histologic) description
  • Diffuse atrophy with crowded and smaller glomeruli, atrophic tubules and interstitial fibrosis (Lab Invest 1991;65:558)
  • Arterioles usually normal
  • Usually no hypertensive changes in small vessels, although opposite kidney may show hypertensive changes
  • Medial fibroplasia: multiple foci of stenosis alternate with microaneurysms to produce “string of beads”
  • Perimedial fibroplasia: normal outer half of media but hyperplasia of muscle causes uniform circumferential thickening of vessel wall with luminal narrowing
  • Intimal fibroplasia: hyperplasia of intima, resembling atherosclerosis, but without lipid deposition
  • Periarterial fibroplasia: rare, fibrosis of adventitia extends into adjacent adipose and connective tissue, causing constriction from without