Materiały źródłowe

• #1 Renal artery stenosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/renal-artery-stenosis/diagnosis-treatment/drc-20352782

  Treatment for renal artery stenosis may involve lifestyle changes, medication and a procedure to restore blood flow to the kidneys. Sometimes a combination of treatments is the best approach. Depending on your overall health and symptoms, you may not need any specific treatment. […] High blood pressure even when mainly related to renal artery stenosis often can be successfully treated with medications. Finding the right medication or combination of medications may require time and patience. […] For certain people a procedure may be recommended to restore blood flow through the renal artery to improve blood flow to the kidney. […] Results from clinical trials comparing medication with renal angioplasty and stenting didn’t show a difference between the two treatment approaches on reducing high blood pressure and improving kidney function for people with moderate renal artery stenosis. Procedures to open the vessel should be considered for people who don’t do well on medicine alone, who can’t tolerate medications, who often retain fluids and who have treatment-resistant heart failure.

• #2 Renal Artery Stenosis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17422-renal-artery-disease

  Renal artery stenosis (RAS) occurs when the arteries that carry blood to your kidneys narrow. Its usually the result of atherosclerosis. Treatments include lifestyle changes, medication or surgery. RAS is a serious condition that can lead to chronic kidney disease or kidney failure. […] The most common treatments for RAS are lifestyle changes and medication. Surgery may be an option if someone develops severe stenosis in their renal arteries, is at risk of arterial occlusion (blockage), has unmanaged high blood pressure resistant to medications or has progressive loss of kidney function. […] Your healthcare provider will likely recommend a variety of lifestyle changes to help manage RAS and lower high blood pressure, including: Eating a healthy diet low in fat, cholesterol, sodium and sugar. Getting regular exercise. Losing weight. Quitting smoking.

• #3 Renal artery stenosis and hypertension: when to screen and how to treat | Medicine Today

  https://medicinetoday.com.au/mt/2023/march/feature-article/renal-artery-stenosis-and-hypertension-when-screen-and-how-treat

  Renal artery stenosis (RAS) is a common cause of secondary hypertension. […] Intensive medical therapy to reduce modifiable cardiovascular risk factors is the cornerstone of management of RAS and should be applied to all patients. […] Patients with stable atherosclerotic RAS are best managed conservatively. […] Endovascular interventions should be reserved for those with fibromuscular dysplasia and for only a select few of those with atherosclerotic RAS. […] However, evidence suggests that renal revascularisation does not generally improve blood pressure, or renal or cardiovascular outcomes in atherosclerotic RAS. […] Optimal care should be based on good medical management of patients risk factors for cardiovascular and kidney disease progression. […] Renin-angiotensin system inhibitors, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), are important in the management of these patients, as they improve survival by reducing cardiovascular events and are often crucial in blood pressure control.

• #4 Renal Artery Stenosis – NIDDK

  https://www.niddk.nih.gov/health-information/kidney-disease/renal-artery-stenosis

  How is RAS treated? Treatment for RAS includes lifestyle changes, medications, and surgery and aims to prevent RAS from getting worse, treat RVH, relieve the blockage of the renal arteries. […] The first step in treating RAS is making lifestyle changes that promote healthy blood vessels throughout the body, including the renal arteries. […] People with RVH may need to take medications thatwhen taken as prescribed by their health care providerlower blood pressure and can also significantly slow the progression of kidney disease. […] Although surgery has been used in the past for treatment of RAS due to atherosclerosis, recent studies have not shown improved outcomes with surgery compared with medication. However, surgery may be recommended for people with RAS caused by FMD or RAS that does not improve with medication. Different types of surgery for RAS include angioplasty and stenting, endarterectomy or bypass surgery.

• #5 Renal Artery Stenosis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17422-renal-artery-disease

  Renal artery stenosis (RAS) occurs when the arteries that carry blood to your kidneys narrow. Its usually the result of atherosclerosis. Treatments include lifestyle changes, medication or surgery. RAS is a serious condition that can lead to chronic kidney disease or kidney failure. […] The most common treatments for RAS are lifestyle changes and medication. Surgery may be an option if someone develops severe stenosis in their renal arteries, is at risk of arterial occlusion (blockage), has unmanaged high blood pressure resistant to medications or has progressive loss of kidney function. […] Your healthcare provider will likely recommend a variety of lifestyle changes to help manage RAS and lower high blood pressure, including: Eating a healthy diet low in fat, cholesterol, sodium and sugar. Getting regular exercise. Losing weight. Quitting smoking.

• #6 Renal Artery Stenosis: Treatment, Symptoms, and More

  https://www.healthline.com/health/renal-artery-stenosis

  Treatment for RAS depends on a combination of medications and lifestyle changes. Certain medical procedures may also be necessary. […] One of the first ways to treat this condition is with medications. Your doctor may prescribe medications to help relax blood vessels so they dont narrow. Options include: angiotensin II receptor blockers (ARBs), calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors. […] Your doctor may also recommend diuretics to reduce swelling and fluid retention. These are available in both prescription and over-the-counter forms. […] Even if you take medications for RAS and other underlying conditions, certain lifestyle changes can help. These include: getting regular exercise, losing or maintaining weight, if necessary, quitting smoking, cutting back on alcohol or caffeine, consuming less sodium, managing stress, getting adequate sleep.

• #7 Medication for Renal Artery Stenosis | NYU Langone Health

  https://nyulangone.org/conditions/renal-artery-stenosis/treatments/medication-for-renal-artery-stenosis

  If your renal arteries are less than 60 percent narrowed, your NYU Langone cardiologist may prescribe medications that lower high blood pressure and control cholesterol levels. This can help reduce the symptoms of renal artery stenosis and prevent kidney damage. […] Your doctor may prescribe medications to lower your blood pressure. There are several types. […] Also called ACE inhibitors, these medications widen, or dilate, blood vessels to improve blood flow. They block angiotensin, an enzyme that causes arteries to narrow. Your doctor may prescribe these medications if you have one narrowed renal artery. […] These medications widen blood vessels and reduce salt and water retention. They may be prescribed for people with renal artery stenosis who cant tolerate ACE inhibitors. […] Diuretics can help reduce blood pressure in the renal arteries. They help the kidneys remove salt and water from the body by increasing urine output.

• #8 Renal Artery Stenosis Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/245023-guidelines

  Medical Therapy ACC/AHA, ESC and SCAI all prefer medical therapy as the first-line treatment for RAS. […] ACC/AHA and ESC recommend ACE inhibitors, ARBs, and calcium channel blockers for unilateral RAS, […] but ESC advises that patients with bilateral severe RAS or RAS in a single functional kidney require very careful monitoring when started on ACE inhibitors or ARBs. […] The ACC/AHA also recommends beta-blockers for treatment of hypertension associated with RAS. […] The ESC considers the use of antiplatelet agents to be part of best medical therapy. […] Revascularization The ACC/AHA guidelines recommend percutaneous revascularization in patients with hemodynamically significant RAS and any of the following: […] In addition, percutaneous revascularization is reasonable for patients with progressive chronic kidney disease (CKD) and bilateral RAS or a RAS to a single functioning kidney and can be considered for unilateral RAS with chronic kidney insufficiency. […] ACC/AHA and ESC recommend renal stent placement for ostial atherosclerotic RAS (class I). […] ACC/AHA gives a class I recommendation for balloon angioplasty with bailout stent placement if necessary for fibromuscular dysplasia lesions; […] whereas ESC recommends considering balloon angioplasty with or without stenting for patients with RAS and recurrent congestive heart failure or sudden pulmonary edema and preserved systolic left ventricular function (class IIb).

• #9 Renal artery stenosis: epidemiology and treatment | IJNRD

  https://www.dovepress.com/renal-artery-stenosis-epidemiology-and-treatment-peer-reviewed-fulltext-article-IJNRD

  Medical therapy is a central pillar in the approach to treatment of RAS. Major goals include glycemic control optimization, cholesterol reduction, smoking cessation, blood pressure reduction, and primary prevention with aspirin, if indicated. According to ACC/AHA guidelines, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and beta-blockers all receive a class I indication for the treatment of hypertension associated with RAS. ACE inhibitors/angiotensin receptor blockers are a mainstay of most hypertensive regimens and have been shown to be 86% to 92% effective. A limitation of modulation of the reninangiotensin system is the potential to induce acute renal failure in patients with RAS to solitary functioning kidneys, severe bilateral stenoses, or advanced chronic kidney disease. While management of hypertension is a primary goal in the treatment of RAS, care should be taken to avoid reducing perfusion pressure so low as to induce ischemic nephropathy in pressure-dependent kidneys. Another major drawback of medical therapy is the apparent inability to prevent progression of existing stenosis, which has been the primary impetus for the development of more permanent and decisive solutions such as surgical and percutaneous revascularization.

• #10 Management of Renal Artery Stenosis – an Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3074287/

  In ARAS, on the other hand, the benefits with PTRA are less clear and the challenge to identify which patients are likely to benefit from revascularisation remains unknown. […] The benefit of intervention must include not only preservation of renal function and improved control of hypertension, but also a reduction in the overall cardiovascular risk. […] All patients with ARAS should receive anti-platelet agents as they reduce morbidity and mortality in cardiovascular disease. […] Calcium-channel blockers, which maintain renal perfusion by reducing afferent arteriolar tone and beta-blockers by lowering renin, are also established options for patients with renovascular disease. […] Many patients with renovascular disease will be candidates for ACE inhibitor and/or angiotensin receptor blockade (ARB).

• #11 Medication for Renal Artery Stenosis | NYU Langone Health

  https://nyulangone.org/conditions/renal-artery-stenosis/treatments/medication-for-renal-artery-stenosis

  Your doctor may recommend taking a low dose of aspirin daily to help prevent blood clots from forming in the renal arteries. […] Your doctor may prescribe medication to prevent plaque from building up in the arteries that lead to the kidneys. These medications, which are called statins, help lower low-density lipoprotein (LDL), or bad, cholesterol, which can clog the arteries. They also raise levels of high-density lipoprotein (HDL), or good, cholesterol, which helps remove unhealthy cholesterol from the body.

• #12 Renal artery stenosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/renal-artery-stenosis/diagnosis-treatment/drc-20352782

  Procedures to treat renal artery stenosis may include: Renal angioplasty and stenting. In this procedure, doctors widen the narrowed renal artery and place a device (stent) inside your blood vessel that holds the walls of the vessel open and allows for better blood flow. […] Renal artery bypass surgery. During a bypass procedure, doctors graft a substitute blood vessel to the renal artery to make a new route for blood to reach your kidneys. Sometimes this means connecting the renal artery to a vessel from somewhere else, such as the liver or spleen. These operations are most often done if angioplasty isn’t successful, or when there’s a need for additional surgical procedures.

• #13 Management of Renal Artery Stenosis – an Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3074287/

  The role of the renal vasculature in eliciting renovascular hypertension (RVH) was established in 1934, when Goldblatt et al. in a classical experimental study demonstrated that partial obstruction of the renal artery increased mean arterial blood pressure (BP). […] There are three possible treatment strategies: medical management, surgery, or percutaneous transluminal renal angioplasty (PTRA) with or without stent implantation. The use of stents has improved the technical success rate of PTRA and also led to lower risk of restenosis, in particular for ostial RAS. PTRA with stenting has therefore replaced surgical revascularisation for most patients with RAS and has led to a lower threshold for intervention. […] The treatment of choice to control hypertension in fibromuscular dysplasia (FMD) is generally accepted to be PTRA.

• #14 Renal Artery Stenosis Treatment Joliet, IL | Renal Artery Angioplasty Orland Park, Bolingbrook

  https://www.advancedmidwestir.com/renal-artery-stenosis-interventional-radiology-new-lenox-il.html

  Narrowing of the renal artery is called renal artery stenosis. This usually occurs due to the accumulation of plaque in the arteries. The plaque is made up of cholesterol and fats and may cause diminished blood flow to the kidneys. […] It is a minimally invasive procedure used to treat renal artery stenosis. Your interventional radiologist uses a catheter (thin tube-like structure) to place a balloon or stent into your narrowed renal artery to widen it. […] The minimally invasive procedure for renal artery angioplasty involves the following steps: Your interventional radiologist administers moderate (light twilight) sedation and local anesthesia and makes a small incision near the hip or groin area. A metallic stent and balloon catheter are inserted into the artery and advanced to the site of plaque formation in the artery. Your IR doctor uses an x-ray camera to view the images of your artery and guide the proper placement of the stent and balloon. Once the stent and balloon are at the site of the plaque, the balloon is inflated to widen the opening and deploy the stent. Your surgeon may suggest the placement of a stent at the site of the plaque formation. Once the stent or balloon is in place, the catheters are removed. The tiny incision is then closed with a bandage.

• #15 How to manage renovascular hypertension

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-13/How-to-manage-renovascular-hypertension

  Surgical revascularisation may be considered for patients undergoing surgical repair of the aorta, patients with complex anatomy of the renal arteries, or after a failed endovascular procedure. […] The renal percutaneous transluminal angioplasty (RPTA) is an accepted and durable treatment strategy when the etiology of RVH is fibromuscular dysplasia. […] According to the current ESC Guidelines on the management of PAD, in the case of indication for angioplasty, stenting is recommended in ostial atherosclerotic RAS. […] In summary, in the care of atherosclerotic RAS patients with refractory HTN, recurrent or refractory congestive heart failure, or worsening renal function, renal revascularisation may be considered, keeping in mind all uncertainties above mentioned.

• #16 Management of Renal Artery Stenosis – an Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3074287/

  Indications for angioplasty of a hemodynamically significant RAS are shown in Table II. […] PTRA with or without stenting is a widely accepted treatment for RAS. […] Endovascular stents have been recommended for failed PTRA (unsatisfactory results or complications) and for treatment of restenotic lesions. […] In FMD, the RAS tends to be post-ostial and highly amenable to PTRA alone. […] The effectiveness of surgical revascularisation has been established in non-randomised retrospective studies, and only two randomised prospective studies are available. […] The majority of patients with ARAS are identified during the investigation of hypertension or chronic renal impairment, whereas FMD rarely results in renal failure. […] Over time there is an approximately 1-mm circumferential deposition of myointimal hyperplasia after PTRA with or without stenting, with resultant luminal narrowing.

• #17 Renal Artery Stenosis: Symptoms & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/renal-artery-stenosis

  More severe cases of renal artery stenosis may require surgery. Renal artery bypass surgery involves grafting a portion of healthy artery onto the renal arteries. This grafted portion circumnavigates the blocked area of the renal artery, creating an alternative route (or bypass) for the blood to take. Many people recover enough within a week to return to work. […] An endarterectomy removes the afflicted portion of the renal arteries and the plaque buildup within that section. After the damaged piece of artery is removed, the healthy segments are reattached. Recovery from this procedure can take up to a month. […] In many cases, renal artery stenosis is reversible. Treatment requires expanding or sometimes removing the damaged portion of the artery. However, some ongoing medications may still be needed even after successful treatment.

• #18 Renal Artery Stenosis Treatment & Management: Approach Considerations, Surgical Care, Consultations

  https://emedicine.medscape.com/article/245023-treatment

  In some institutions, PTAS is the first-step approach in patients with ischemic renal disease, and practitioners reserve surgery for the technical failure of percutaneous maneuvers. However, surgery remains the first choice of treatment under certain conditions, including the following: Simultaneous abdominal aortic aneurysm, Renal artery aneurysm, Renal artery occlusion (with unsuccessful thrombolysis), Renal artery rupture, Renal artery stenosis secondary to kinking, Peripheral multifocal stenosis, Unsuccessful angioplasty. […] A small, retrospective review of 20 patients older than 55 years with chronic kidney disease and proximal renal artery stenosis who underwent a revascularization procedure (ie, surgery, PTA, PTAS) revealed a high complication rate (increased serum creatinine concentration in 25%, eosinophilia in 5%, atheroemboli in 15%, renal artery dissection in 5%) and improved serum creatinine values in only 25%. […] PTA is the treatment of choice for renal artery fibromuscular dysplasia. […] In kidney transplant recipients, PTA and PTAS are the standard of care for renal artery stenosis.

• #19 Surgery for Renal Artery Stenosis | NYU Langone Health

  https://nyulangone.org/conditions/renal-artery-stenosis/treatments/surgery-for-renal-artery-stenosis

  At NYU Langone, our specialists sometimes perform surgery to manage the symptoms of renal artery stenosis and prevent complications. Good candidates for surgery are people with severe narrowing greater than 60 to 70 percent of the artery’s diameter. People without symptoms or evidence of damage to the arteries or kidneys typically don’t require surgery. […] Angioplasty with stent placement is typically the first procedure used for people with renal artery stenosis because it’s minimally invasive and involves less recovery time than conventional surgery. Percutaneous balloon angioplasty and stenting can increase blood flow to the kidneys, lower blood pressure, and prevent complications such as kidney damage. […] In a renal artery bypass surgery, blood flow is redirected around a blockage in one or more of the renal arteries with a graft made from a synthetic tube or a healthy vein from another part of the body. […] In a renal endarterectomy, which is no longer commonly performed, your doctor removes plaque, the waxy substance blocking the renal artery and restricting blood flow to the kidneys.

• #20 Diagnosis and treatment of renal artery stenosis | Nature Reviews Nephrology

  https://www.nature.com/articles/nrneph.2009.230

  A reduction in the diameter of the renal arteries can lead to hypertension, renal dysfunction and/or pulmonary edema. […] Patients who undergo revascularization to treat hypertension associated with atherosclerotic stenosis need to continue medication with statins, antiplatelet agents and renin-angiotensin antagonists after the procedure to prevent renal and cardiovascular events. […] Available results favor a conservative approach (medication only) for most patients with atherosclerotic renal artery stenosis. […] Blood pressure outcome after angioplasty is more favorable in patients with fibromuscular renal artery disease, who usually do not have renal failure, than in those with atherosclerosis. […] Patients with atherosclerotic RAS and a stable condition should be treated first with medication.

• #21

  https://step2.medbullets.com/renal/120701/renal-artery-stenosis

  Medical […] ACE-inhibitors or ARBs […] indications […] persistent hypertension in patients with RAS […] contraindicated in bilateral RAS or RAS in patients with single kidney […] calcium channel blockers or -blockers […] given if patients do not respond to ACE-inhibitors or ARBs […] manage lipid disorders with statins […] […] […] Operative […] revascularization […] indications […] severe complications of RAS […] unexplained heart failure […] unexplained pulmonary edema […] chronic kidney disease […] inadequately controlled hypertension […] outcomes […] may not improve outcomes in those with atherosclerotic RAS […] cures up to 58% of hypertension in patients with fibromuscular dysplasia-associated RAS […] complications […] contrast-induced acute kidney injury or allergic reaction […] bleeding, hematoma, or arteriovenous fistula […] […] […] Complications […] Renal dysfunction can progress to end-stage renal disease […] treatment […] dialysis and kidney transplant

• #22 Management of Renal Artery Stenosis – an Update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3074287/

  Several ongoing randomised studies will help to clarify effects of and indications for PTRA of RAS in the future. […] In patients with RVH the likelihood of cure of hypertension is highest among those with FMD. In patients with ARAS, control of hypertension is facilitated by PTRA. Cure of hypertension is unusual. Improved control with fewer medications and preservation of renal function is a more realistic goal.

• #23 Renal Artery Stenosis Causes, Symptoms, Treatment, Diagnosis

  https://www.medicinenet.com/renal_artery_stenosis/article.htm

  Which patients can benefit from surgical procedures for renal artery stenosis? In patients with renal failure due to bilateral renal artery stenosis (narrowing on both kidneys), angioplasty procedures for both renal arteries may improve or stabilize kidney function. Similarly, in hypertensive patients with unilateral (one-sided) renal artery stenosis, angioplasty procedures of the involved renal artery may cure or improve the high blood pressure.

• #24 Percutaneous renal artery intervention versus medical therapy in patients with renal artery stenosis: a meta-analysis | EuroIntervention

  https://eurointervention.pcronline.com/article/percutaneous-renal-artery-intervention-versus-medical-therapy-in-patients-with-renal-artery-stenosis-a-meta-analysis

  Aims: Patients with renal artery stenosis are treated with percutaneous intervention, but randomised studies are inconclusive. We aimed to compare renal percutaneous revascularisation versus medical therapy. […] We did not find a significant improvement in blood pressure or renal function in patients with renal artery stenosis treated with renal artery revascularisation compared to medical therapy alone. However, trial quality was a limitation. […] Over 40,000 percutaneous renal artery interventions are performed in the United States on a yearly basis. The most common indications for these procedures include refractory hypertension, preservation of renal function and cardiac destabilisation syndromes, including congestive heart failure and unstable angina. […] This meta-analysis of 1,030 patients who received renal artery intervention and medical therapy for ARAS or medical therapy alone showed a trend toward, but no statistically significant benefit of, PTRI in combination with medical therapy on SBP, DBP, or SCr.

• #25 Percutaneous renal artery intervention versus medical therapy in patients with renal artery stenosis: a meta-analysis | EuroIntervention

  https://eurointervention.pcronline.com/article/percutaneous-renal-artery-intervention-versus-medical-therapy-in-patients-with-renal-artery-stenosis-a-meta-analysis

  The patient diagnosed with ARAS should first undergo aggressive medical therapy for hypertension. The question whether to also treat with PTRI remains. Based on the data so far available, it appears that patients who have bilateral ARAS or ARAS of a solitary functioning kidney benefit most from PTRI. In unselected patients with unilateral ARAS, the effects of revascularisation in addition to optimal medical therapy are probably small and have not been proven by our meta-analysis. However, because of the limitations of the studies published up to this point, the data needs to be interpreted with caution.

• #26 Renal Artery Stenosis: Causes, Symptoms, Diagnosis, and Treatments

  https://www.webmd.com/hypertension-high-blood-pressure/renal-artery-stenosis-symptoms-treatments

  If you’re diagnosed with renal artery stenosis, it’s important to discuss the risks of the different treatments with your doctor. The side effects of blood pressure medications may include dizziness, sexual problems, headache, and cough. Complications of angioplasty include bruising, bleeding, additional kidney damage, and the possibility that the arteries can close again.

• #27 Treatment of hypertension in patients with renal artery stenosis due to fibromuscular dysplasia of the renal arteries – Chrysant – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/3369/html

  Renal artery stenosis (RAS) from fibromuscular dysplasia (FMD) is an uncommon cause of hypertension that affects mostly women. The treatment of choice of hypertension due to FMD is percutaneous renal angioplasty (PTRA). […] In these patients, the treatment of choice is percutaneous renal angioplasty (PTRA) with stent placement in selected cases medical therapy, which frequently leads to very good control of hypertension. […] The treatment of choice in patients with RAFMD with hypertension is PTRA, with or without stent placement. This leads to successful control of BP either alone or less frequently in combination with pharmacological antihypertensive treatment. […] In contrast, in patients with ARAS, PTRA is less frequently successful in lowering the BP and will often require the addition of medical therapy.

• #28 Treatment of hypertension in patients with renal artery stenosis due to fibromuscular dysplasia of the renal arteries – Chrysant – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/3369/html

  The following paragraphs summarize findings from studies evaluating the effectiveness and safety of PTRA in patients with RAFMD and hypertension either alone or in combination with antihypertensive drugs. […] The initial success rate with improved or cured hypertension was 92%, but hypertension recurred later in 42% of patients. […] The short-term reduction of SBP with PTRA was from (mean SEM) 162.23.8 to 132.62.4 mmHg (P0.001), and for the diastolic BP (DBP) from 83.42.3 to 65.53.1 mmHg (P0.001). […] The long-term (4.80.5 years) reduction in SBP was 142.63.6 mmHg from baseline (P0.001), and in DBP 76.52.4 mmHg from baseline (P=0.02). […] The age and duration of hypertension are very important. […] The treatment of hypertension due to RAFMD can be either medical, interventional, or the combination of both. The drugs of choice are those that block the RAAS, such as angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and direct renin inhibitors (DRI) since this type of hypertension is renin dependent.

• #29 Renal Artery Stenosis Treatment & Management: Approach Considerations, Surgical Care, Consultations

  https://emedicine.medscape.com/article/245023-treatment

  All patients with significant ( 80%) bilateral stenosis or stenosis in a solitary functioning kidney are candidates for revascularization, regardless of whether they have kidney insufficiency. When kidney insufficiency is present, patients with unilateral stenosis are also possible candidates for revascularization. The criteria are slightly different depending on the presence or absence of kidney insufficiency. […] When kidney function is normal or nearly normal, specialists recommend revascularization for prevention of kidney insufficiency if the patient meets the following criteria: The degree of stenosis is more than 80-85%. The degree of stenosis is 50-80% and captopril-enhanced scintigraphy demonstrates an activation of intrarenal renal artery stenosis. […] Conversely, physicians can choose observation instead of revascularization (serial control every 6 mo with duplex ultrasound scanning, correction of dyslipidemia, use of drugs that block platelet aggregation) when the patient meets either of the following criteria: Stenosis is 50-80% and scintigraphy findings are negative. The degree of stenosis is less than 50%.

• #30 Renal Artery Stenosis Treatment & Management: Approach Considerations, Surgical Care, Consultations

  https://emedicine.medscape.com/article/245023-treatment

  When kidney insufficiency is present and the objective is recovery of kidney function together with prevention of further kidney function impairment, the prerequisites for revascularization are as follows: The serum creatinine level is lower than 4 mg/dL, or The serum creatinine level is higher than 4 mg/dL but with a possible recent renal artery thrombosis. […] When either of those conditions is satisfied, the authors propose revascularization if the following apply: The degree of stenosis is more than 80%. The serum creatinine level rises after administration of angiotensin-converting enzyme (ACE) inhibitors. The degree of stenosis is 50-80% and scintigraphy findings are positive. […] Restrict conservative treatment in patients with an established diagnosis of ischemic renal disease to those with absolute contraindications to surgery or angioplasty or to patients who are likely to succumb to other comorbid conditions before advancing to end-stage renal disease because of ischemic renal disease. Clinicians must rely on pharmacologic agents (eg, combination of calcium channel blockers to control blood pressure and optimize renal perfusion), accepting the high probability of deterioration in kidney function and shortened survival.

• #31 Renal Artery Stenosis Management Strategies: An Updated Comparative Effectiveness Review | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/renal-update/research

  Based on the evidence, subsets of patients benefit from revascularization, but the evidence does not clearly define who these patients are, except that case reports demonstrate that some patients with acute decompensation benefit from revascularization. […] New studies or reanalyses of data in existing studies are needed to better understand the comparative effectiveness of PTRAS versus medical therapy.

• #32 Renal artery stenosis and hypertension: when to screen and how to treat | Medicine Today

  https://medicinetoday.com.au/mt/2023/march/feature-article/renal-artery-stenosis-and-hypertension-when-screen-and-how-treat

  Many nonrandomised studies suggest that revascularisation in atherosclerotic RAS improves renal function and blood pressure; however, the potential biases of a nonrandomised design are well known. […] A restricted subset of individuals with atherosclerotic RAS is still considered suitable for endovascular treatment, including individuals with: haemodynamically significant (70% stenosis) RAS causing resistant hypertension despite maximal medical therapy. […] Based on his poorly controlled hypertension and evidence of renal damage, including a shrunken kidney, proteinuria, and reduced eGFR, the patient was referred to a nephrologist. […] Judicious selection of individuals with progressive complications of their RAS may warrant referral for endovascular intervention.

• #33

  https://link.springer.com/article/10.1007/s11936-011-0111-3

  Renal artery stenosis (RAS) is a relatively common manifestation of atherosclerosis, although in a small percentage of cases it is due to fibromuscular dysplasia and less frequently may have other etiologies. RAS may be treated by revascularization, using either percutaneous or open surgical techniques. Currently, technical success with percutaneous revascularization utilizing angioplasty and stenting is achieved in 95% or more of cases in which it is attempted. Despite this, at least one third of patients undergoing renal artery stenting do not receive any measurable benefit. Furthermore, randomized trials of stenting for RAS have failed to demonstrate a benefit over medical management alone. Thus, the clinician is faced with a challenge when determining how to manage an individual patient with RAS. In the current era, all patients with RAS should receive optimal medical therapy. This approach should use medicines to control blood pressure, and specifically utilize agents proven to reduce cardiovascular morbidity and mortality. Other components of optimal medical therapy include the use of anti-platelet drugs such as aspirin and statins to minimize progression of atherosclerosis. In addition to these strategies, consideration should be given to revascularization therapy. When deciding to revascularize RAS, the patient should have an appropriate clinical indication, in addition to a significant anatomic stenosis. Importantly, stents should not be placed due to the oculostenotic reflex. Specifically, patients who continue to have uncontrolled blood pressure or worsening renal function despite an aggressive approach with medical therapy may be particularly good candidates for renal artery stenting. Despite the lack of benefit in randomized trials to date, there is likely still a role for renal artery stenting in RAS; however, careful patient selection is essential to maximize the potential benefit.

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