Renal Artery
Different from renal artery stenosis in that it is bilateral and more gradual
What our notes say
- Different from renal artery stenosis in that it is bilateral and more gradual (Renal Vascular Diseases: Nephrosclerosis & Renal Artery Stenosis)
- Reduced renal perfusion: hepatorenal syndrome, NSAIDs and ACE inhibitors or ARBs, renal artery stenosis. (Junior Clerkship in Internal Medicine (MBIM4100) main exam, Paper One: 31 Januar)
- Vascular: renal artery or vein thrombosis, vasculitis, thrombotic microangiopathy (HUS and TTP), malignant hypertension. (Junior Clerkship in Internal Medicine (MBIM4100) main exam, Paper One: 31 Januar)
- | Renal artery stenosis | Abdominal bruit, flash pulmonary oedema, creatinine rise on ACE inhibitor; Doppler or CT angiography | (Hypertension)
- MR angiography reveals focal narrowing with thickening and beading of the left main renal artery. (renal pathology — Past Paper Questions & Answers)
- She has a 'Goldblatt' kidney from narrowing of one renal artery, leading to an increase in renin, with hypertension, and the subsequent hypertensive changes can eventually damage the opposite kidney. (renal pathology — Past Paper Questions & Answers)
Study material on Renal Artery
- Renal Vascular Diseases: Nephrosclerosis & Renal Artery Stenosis
- Junior Clerkship in Internal Medicine (MBIM4100) main exam, Paper One: 31 January 2024
- Renal Anatomy and Physiology
Practice questions on Renal Artery
Renal artery stenosis causes hypertension primarily through which mechanism?
- Increased sympathetic nervous system activity directly affecting vascular tone
- Activation of the renin-angiotensin-aldosterone system (RAAS) due to reduced renal perfusion
- Reduced glomerular filtration rate leading to volume overload
- Endothelial dysfunction and impaired nitric oxide production
Answer: B. Renal artery stenosis reduces blood flow to the juxtaglomerular apparatus, which stimulates renin release, activating the RAAS and causing hypertension. This is secondary hypertension. ---
The most appropriate initial diagnostic test for suspected renal artery stenosis (RAS) is
- Renal biopsy
- Angiography (gold standard, but invasive)
- CT angiography or MR angiography (MRA)
- Renal ultrasound with Doppler (often first line, non-invasive screening)
Answer: D. Renal ultrasound with Doppler is a common first-line screening test due to its non-invasiveness, though its sensitivity/specificity are operator-dependent. CT angiography and MR angiography are more definitive non-invasive tests. Angiography is the gold standard but invasive. RAS should be suspected in sudden onset or refractory hypertension, especially with unexplained AKI after starting ACEi/ARB, or asymmetric kidn