RAS & RVH Diagnosis
The diagnostic method used for renal artery stenosis (RAS) is similar to that used for ischemic nephropathy. The physician may also measure and compare the level of renin, (blood pressure-regulating hormone released by the kidneys), within the right to the left renal veins. If the amount of renin that is released by one-side is markedly higher than the other, this identifies a high renin-releasing kidney consistent with RAS.
Treatment for RAS & RVH
Medication (e.g., antihypertensive drugs) may be used to control hypertension (high blood pressure).
Diuretics, ACE inhibitors, beta blockers, calcium channel blockers, and angiotensin receptor blockers (ARBs) may be effective. A selective aldosterone inhibitor (e.g., eplerenone [Inspra]) may be used to treat mild RAS.
These medications are discontinued if they cause a decrease in renal function. In some cases, patients with RAS are resistant to medication for control of blood pressure.
Angioplasty and stenting may be used to improve blood flow. The goal is to improve the circulation of blood flow to the kidney and prevent the release of excess renin, which can help to decrease blood pressure. This helps to prevent atrophy of the kidney. In general, patients with AS-RAS should have stenting done because plasty by itself has a very high incidence of re-stenosis.
Surgery to bypass the narrowing may be performed. If the kidney with RAS has atrophied, a nephrectomysurgical removal of the kidneymay be advised.
RAS & RVH Prognosis
Patients with fibromuscular dysplasia (FMD) RAS often have good, long-term results with angioplasty, but those with atherosclerotic RAS frequently experience a recurrence. Even after partial or complete repair of the narrowed blood vessel, most patients still have hypertension, but require less medication to control it.