Renal artery stenosis overview

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Renal artery stenosis Microchapters


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Differentiating Renal artery stenosis from other Diseases

Epidemiology and Demographics

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivam Singla, M.D.[2]





  • Additionally, renal artery stenosis is classified anatomically according to the severity of luminal narrowing.
  • The following criteria are used according to most published studies about ARAS.
  • To note, some studies have different classification criteria than those listed above, with "mild disease" starting after 50% of luminal narrowing. Such classification remains coherent with the definition of ARAS as narrowing > 50%.
  • Another classification is based on hemodynamic function in RAS. This classification simply differentiates between hemodynamically insignificant Renal artery stenosis (< 75% stenosis) and hemodynamically significant Renal artery stenosis (> 75% stenosis).

Epidemiology and Demographics

  • The true prevalence of ARAS has not been reliably determined and prevalence rates present so far may in fact be an underestimate or an overestimate of the true prevalence due to the varying selection criteria in different studies.

Risk Factors


  • Non-invasive diagnosis is the first line for the screening of ARAS.
  • The invasive diagnostic technique, such as renal angiography, is considered the gold standard for diagnosis and may be used when
  • Concomitant catheterizations are needed or when previously performed non-invasive techniques yielded equivocal results.


  • Medical therapy is considered the first line of management for patients with ARAS.
  • According to the 2013 ACC/AHA Guidelines for the Management of PAD, ACE-I and CCB may be used in patients with RAS because they have an effect on both lowering BP and delaying the renal disease.
  • Although ARBs may be used as well, they still have level B evidence for use in ARAS because trials have not been conducted on the use of ARBs in such patients.
  • Angioplasty and stent implantation were previously recommended by the 2013 ACC/AHA Guidelines. However, emerging data from the CORAL trial showed that although there are high technical success rates with angioplasty/stenting, the clinical endpoints are inconsistently and modestly modified. Therefore, raising the suspicion that PRI (percutaneous renal interventions) can incur substantial costs without a significant public health advantage
  • Vascular reconstruction of the renal arteries may be indicated in a small minority of patients. However, surgical reconstruction is associated with complications and carries a 5-15% for surgical re-intervention.

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