How is RAS prevented in patients with renovascular hypertension (RVHT)?

Updated: Dec 01, 2020
  • Author: Rebecca J Schmidt, DO, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Atherosclerotic RAS is now recognized as an important and fast-growing cause of end-stage renal disease. Because this form of renal failure can be prevented by performing an operation or angioplasty, it is important to identify patients who may be at risk for renal ischemia as a result of atherosclerosis. Even when renal function is impaired, relief of the stenosis, if achieved early enough, may result in dramatic improvement.

Factors that should prompt evaluation for renal artery disease include the following [1, 2] :

  • Onset of hypertension before age 30 years
  • Accelerated, resistant, or malignant hypertension
  • Elevation in serum creatinine of more than 30% after starting an angiotensin- converting enzyme inhibitor or angiotensin-receptor blocker
  • New onset of hypertension after 50 years of age (suggests atherosclerotic renal artery stenosis)
  • Asymmetric kidneys with more than 1.5 cm of difference in the size and otherwise unexplained loss of kidney function
  • Sudden unexplained pulmonary edema
  • Abdominal bruit on physical examination

Deterioration of kidney function in the setting of diffuse atherosclerosis without proteinuria or known renal parenchymal disease, even in the absence of hypertension, is highly suggestive of renovascular disease.


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