Nature Nephrology, one of my favorite journals talks about the recent trials and overall summary of the diagnosis and treatment of renal artery stenosis. What I loved about the article is an overall summation of all studies that is noted in table 2. In Box 1, they also list other causes of renal artery stenosis that we often forget to look for:- fibromuscular dysplasia, arterititis( PAN, Takayasu), Tuberous Sclerosis, vascular Ehlers Danlos Syndrome, Renal artery spasm, etc.
Basically, this review article concludes that atherosclerotic renal artery stenosis should be aimed at prolonging the period that is free from cardiovascular or renal events. Age and age related risk factors, vascular disease, hypertension, renal function and kidney size all are determining factors of how patients should be treated.
Patients with FMD should be treated more aggresively with stenting as angioplasty has a better blood pressure outcome in FMD than atherosclerotic RAS. but again, each case has to be taken on an individual basis, based on age and other co morbid factors.
Image courtesy: vascularweb.com
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