Clinical manifestations and diagnosis of chronic kidney disease resulting from atherosclerotic renal artery stenosis
- Stephen Textor, MD
Stephen Textor, MD
- Professor of Medicine
- Division of Nephrology and Hypertension
- Mayo Clinic College of Medicine
- Rochester, Minnesota
- Lionel U Mailloux, MD, FACP
Lionel U Mailloux, MD, FACP
- Clinical Professor of Medicine
- Hofstra Northwell School of Medicine
- Section Editors
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
INTRODUCTION AND DEFINITION
Many but not all patients with atherosclerotic renal artery stenosis have chronic kidney disease (CKD) that is primarily due to a reduction in blood flow induced by the stenosis. In general, clinically progressive CKD (marked by an increase in the serum creatinine) occurs when the stenosis threatens the entire renal mass. Hence, patients with CKD resulting from atherosclerotic renal artery stenosis usually have high-grade stenosis of both renal arteries or stenosis to a solitary functioning kidney.
However, renal artery stenosis may be an "incidental" finding in patients who have CKD that is caused by a separate disorder (eg, diabetic nephropathy). It can be difficult to distinguish between patients whose disease is induced by renal artery stenosis and those who have an alternative cause of CKD.
Ischemic nephropathy is discussed in this topic. Determining which hypertensive patients to evaluate for renal artery stenosis, establishing the diagnosis of renal artery stenosis, and treatment of patients with unilateral or bilateral atherosclerotic renal artery stenosis are presented elsewhere. (See "Evaluation of secondary hypertension" and "Establishing the diagnosis of renovascular hypertension" and "Treatment of unilateral atherosclerotic renal artery stenosis" and "Treatment of bilateral atherosclerotic renal artery stenosis or stenosis to a solitary functioning kidney".)
In addition, the diagnosis and treatment of fibromuscular dysplasia are discussed in other topics. (See "Clinical manifestations and diagnosis of fibromuscular dysplasia" and "Treatment of fibromuscular dysplasia of the renal arteries".)
DEFINITION AND TERMINOLOGY
Chronic kidney disease (CKD) that results from atherosclerotic renal artery stenosis is frequently called ischemic nephropathy [1-3]. Broadly speaking, "ischemic nephropathy" can refer to a reduction in glomerular filtration rate (GFR) produced by any cause of diminished renal blood flow. In principle, this could include ischemic acute tubular necrosis, intrarenal arterial or capillary obstruction due to vasculitis, coagulation or hemolytic disorders (such as a thrombotic microangiopathy or sickle cell disease), or immune deposits (as with glomerulonephritis).
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