Atherosklerotische Nierenarterienstenose

Abstract

The most common cause of obstructive renal artery disease is atherosclerosis, accounting for 90 % of cases of renal artery stenosis. Atherosclerotic renal artery stenosis can be associated with renovascular hypertension, ischemic nephropathy, or both or it may occur alone. The prevalence of atherosclerotic renal artery stenosis among hypertensive patients is estimated between 1 and 5 %, but the frequency rises among patients with refractory hypertension (20 %) coronary heart disease (15 to 20 %) or peripheral arterial disease (30 to 40 %). The gold standard for diagnosing renal artery disease is contrast renal arteriography. MR angiography, CT angiography and color duplex ultrasonography have the highest sensitivity and specifity among the non invasive screening methods. Therapy is based on consequent medical treatment of hypertension, antiplatelet therapy and modification of risk factors for atherosclerosis. Revascularisation is advised in patients with severe hypertension, in patients with pulmonary edema and cases of acute worsening of renal function. Percutaneous angioplasty with stent implantation is the method of choice for revascularisation. The prognosis of patients with atherosclerotic renal artery stenosis is determined by cardiovascular and renal complications.

Prevalence and Predictors of Renal Artery Stenosis in Hypertensive Patients Undergoing Elective Coronary Procedures

“…Atherosclerosis is the most common cause of obstructive renal artery disease, accounting for 90% of cases of renal artery stenosis (RAS) 1 . Hemodynamically significant RAS is a well‐recognized cause of systemic arterial hypertension, renal insufficiency, or both 2 .…”

Comparison of contrast-enhanced magnetic resonance angiography and digital subtraction angiography in the evaluation of renal artery stenosis and detecting of accessory and polar arteries

“…In 12-14% of dialysis patients and 1-5% of hypertensive patients, the underlying cause is atherosclerotic renal artery stenosis. It is found at increasing rates as in 15% of persistent hypertension, 20% of coronary heart disease, and 30-40% of peripheral artery disease cases [2][3][4].…”