Kidney nontumor / medical renal
Vascular disease
Hypertensive renal disease
Renal artery stenosis
Author: Nikhil Sangle, M.D.
Last author update: 3 December 2012
Last staff update: 30 June 2022
Copyright: 2002-2024, PathologyOutlines.com, Inc.
PubMed Search: Blood vessel disorders renal artery stenosis
Table of Contents
Definition / general | Causes | Case reports | Treatment | Gross description | Microscopic (histologic) descriptionCite this page: Sangle N. Renal artery stenosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/kidneyrenalartstenosis.html. Accessed April 20th, 2024.
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
- 4 year old boy with segmental renal artery stenosis (Am J Surg Pathol 1994;18:512)
- 35 year old woman with aortic coarctation and renal artery stenosis due to fibromuscular dysplasia (Arch Pathol Lab Med 1989;113:809)
- 53 year old woman with renal artery stenosis (BMJ Case Rep 2012;2012: bcr2012006499)
Treatment
- Anti-hypertensive medications
- Angioplasty with stent placement may be effective, even in transplanted kidney (Nefrologia 2012;32:455)
- Revascularization is usually not effective for atherosclerotic renovascular disease (Nephrol Dial Transplant 2012;27:3843, Cardiol Rev 2012;20:189)
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
