Renal Vascular Disease

What is Renal Vascular Disease?

Renal vascular disease encompasses a variety of issues that affects the blood circulation of the arteries and veins involving the kidneys. Poor blood flow to the kidneys may cause kidney damage, kidney failure, and high blood pressure.

Renal vascular disease is often associated with high blood pressure because when blood flow to the kidneys is decreased, extra renin may be produced. Renin is a powerful hormone that increases blood pressure.

Renal vascular disease includes renal artery stenosis, renal artery thrombosis, aneurysm, atheroembolic renal disease, and renal vein thrombosis. 

Renal Artery Stenosis

Renal artery stenosis (RAS) is a blockage of an artery to the kidneys that may cause kidney failure and high blood pressure.

Renal Artery Thrombosis

Renal arteries bring oxygenated blood to the kidneys. Renal artery thrombosis is the formation of a clot in a renal artery, which may cause kidney failure.

Renal Artery Aneurysm

A renal artery aneurysm is a bulging, weakened area in the wall of a renal artery. 

Atheroembolic Renal Disease

Plaque from the aorta or larger arteries can break off, travel to, and block smaller arteries, such as the renal arteries. This condition is known as atheroembolic renal disease. Atheroembolic renal disease is a common cause of poor kidney function in the elderly.

Renal Vein Thrombosis

Renal vein thrombosis is the formation of a clot in a vein to the kidney.

At Yale Vascular Surgery, we offer the widest range of treatment and management options for renal vascular disease. In addition to being well-versed with the traditional or classic techniques and surgeries, many additional procedures offered by our innovative surgeons are at the leading edge of vascular surgery. Our multidisciplinary vascular team works collectively to create personalized treatment plans that provide the best options for each patient, reflecting his or her specific condition and individual needs.

Causes of Renal Vascular Disease

The cause of renal vascular disease will depend on the specific condition involved Below describes some of the causes for renal artery stenosis, renal artery thrombosis, renal artery aneurysm, atheroembolic renal disease, and renal vein thrombosis.

Renal Artery Stenosis

Stenosis, or blockage, of a renal artery may be caused by any of the following:
Atherosclerosis: a buildup of plaque on the inner lining of the artery wall. Atherosclerosis is the major cause of renal artery stenosis in the U.S.

Fibromuscular dysplasia: a rare disorder characterized by abnormal cellular growth in the walls of medium and large arteries.

Takayasu's arteritis: a rare inflammatory disease that affects the aorta and its branches (including the renal arteries). 

Renal Artery Thrombosis

There are several conditions that may cause the formation of a blood clot, or thrombosis, inside a renal artery. Some of these conditions include: 
  • Trauma 
  • Infection
  • Inflammatory disease
  • Renal artery aneurysm
  • Renal cell cancer
  • Fibromuscular dysplasia

Renal Artery Aneurysm

There are four types of renal artery aneurysms, each having a different main cause. The types include saccular, fusiform, dissecting, and intrarenal. 
Saccular
Saccular aneurysms bulge on only one side of the artery. They may result from a congenital weakness of an artery wall, trauma, or atherosclerosis. 
Fusiform
Fusiform aneurysms bulge on all sides of the artery. They often occur with fibromuscular dysplasia. 
Dissecting
This type of aneurysm occurs when an artery wall is weakened from a tear in the inner layer of the artery wall.
Intrarenal
This type of aneurysm occurs on an artery inside the kidney and may occur due to a congenital disorder or trauma.

Atheroembolic Renal Disease

Atheroembolic renal disease can be caused by surgery, insertion of a catheter, or the use of blood-thinning medications. 

Renal Vein Thrombosis

Renal vein thrombosis, or blood clots in a renal vein, are often associated with conditions caused by trauma, tumors, an aneurysm, nephrotic syndrome, pregnancy, administration of steroid medications, and use of oral contraceptives.

Symptoms of Renal Vascular Disease

Symptoms of renal vascular disease vary depending on the type of disease. Below is a list of symptoms for each of the types: renal artery stenosis, renal artery thrombosis, renal artery aneurysm, atheroembolic renal disease, and renal vein thrombosis.

Renal Artery Stenosis

  • Sudden onset of hypertension
  • Hypertension not responsive to three or more blood-pressure medications
  • Increased urea (a waste product excreted by the kidneys) in the blood
  • Unexplained kidney failure
  • Sudden kidney failure when first taking an angiotensin-converting enzyme (ACE) inhibitor medication for blood pressure and/or heart treatment

Renal Artery Thrombosis

Symptoms vary depending on whether the thrombosis occurs suddenly with complete blockage or has developed over time. Gradual occurrence may be asymptomatic (no symptoms).

Symptoms associated with sudden complete blockages include:
  • Sudden onset of pain in the area between the ribs and the upper part of the hip bone 
  • Fever
  • Blood in the urine
  • Nausea and/or vomiting
  • Sudden decrease in kidney function
  • Hypertension

Renal Artery Aneurysm

In most cases, renal artery aneurysms produce no classic symptoms, though hypertension may be present.

Dissecting aneurysms may cause pain in the area between the ribs and the upper part of the hip bone. Blood in the urine may also be present.

Atheroembolic Renal Disease

  • Skin lesions 
  • Discolored areas, known as mottling, of the toes and feet
  • Kidney failure 
  • Abdominal pain
  • Diarrhea
  • Confusion
  • Weight loss
  • Fever
  • Muscle aches

Renal Vein Thrombosis


Symptoms vary depending on whether the thrombosis occurs suddenly with complete blockage or has developed over time. Gradual occurrence may be asymptomatic (no symptoms).

Symptoms associated with sudden complete blockages include:
  • Persistent severe pain in the area between the ribs and the upper part of the hip bone that sometimes may be spasmodic 
  • Soreness in the area over the kidney, between the ribs and the backbone
  • Decreased kidney function
Having one or more of the above symptoms does not mean that you have a renal vascular disease. This list should be used as a guideline only. If you are experiencing one or more of the above symptoms, please call your doctor. 

Risk Factors of Renal Vascular Disease

At Yale Vascular Surgery, we emphasize patient education, risk-factor reduction, and management. Knowing your risk factors for any disease can help to guide you to the appropriate actions, including changing certain behaviors and being clinically monitored for the disease.

Risk factors for renal vascular disease include:
  • Age
  • Female gender
  • Atherosclerosis
  • Hypertension
  • Smoking
  • High cholesterol
  • Diabetes
It is important to understand that having one or more of the risk factors does not mean that you will develop renal vascular disease. The list should be used only as a guideline. 

Diagnosing Renal Vascular Disease

If you think you have renal vascular disease, it is important to get a diagnosis so that you can begin treatment and management of the disease to prevent further issues.

Yale Vascular Surgery uses the most innovative techniques to diagnose vascular conditions so that you can receive a timely and accurate diagnosis. In addition to using diagnostic procedures, our surgeons take the time to discuss your medical history and perform a physical examination.

Below describes the most common diagnostic procedures: 

Arteriogram (also called an angiogram)
An arteriogram is an X-ray image of the blood vessels. A dye is injected into the artery through a thin, flexible tube. This dye makes the blood vessels visible on the X-ray.

Duplex ultrasound 
A duplex ultrasound assesses the blood flow and the structures of the leg veins. The term "duplex" refers to the fact that two modes of ultrasound are used (Doppler and B-mode). The B-mode refers to a transducer (wand-like device) that is used to create an image of the vessel while the Doppler probe within the transducer evaluates the blood flow within the vessel.

Renography
Renography is a specialized radiology procedure used to assess the function and structure of the kidneys. During the procedure, a tiny amount of a radioactive substance is used to assist in the examination of the kidneys.

Magnetic Resonance Angiography (MRA)
An MRA uses a combination of magnetic resonance imaging (MRI) technology and intravenous (IV) contrast dye. The dye creates a contrast so that blood vessels can be visible on the MRI image. 

Treatment of Renal Vascular Disease

At Yale Vascular Surgery, our team includes nationally renowned surgeons who are dedicated to helping patients affected by vascular disease and who have continually excelled in caring for patients with renal vascular disease. They will help determine the best-possible comprehensive treatment by using the latest technology and compassionate care.

Should you require surgery, our surgeons will review your surgical plan with you, in detail, so that you know what to expect before, during, and after the surgery.

The management and treatment procedure for the disease depends on the type of renal vascular disease and on a number of other factors, including: 
  • Age of patient
  • Patient’s overall health and medical history
  • Extent of the disease
  • Signs and symptoms
  • Patient’s tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Patient’s preference 

Below is a list of the most common treatments associated with the varying types of renal vascular disease. 

Renal Artery Stenosis

Medical Management
  • The most common medicines used for patients with renal artery stenosis include: 
  • High blood pressure medications (other than ACE inhibitors) 
  • Medications to lower cholesterol may be prescribed in cases when atherosclerosis causes the stenosis 
  • Medications to manage any related conditions, such as diabetes
Surgical Procedures
  • The most common surgical procedures for patients with renal artery stenosis are endovascular procedures and open surgical procedures. 
  • Endovascular procedures
  • Endovascular procedures include methods to open the artery. The most common endovascular techniques are angioplasty (Endovascular Angioplasty), which uses a balloon or other method to open the blocked artery, or the placement of a stent (Endovascular Stent Repair), which is a tiny, expandable metal coil placed inside an artery to keep the artery open.
Open Surgery
Open surgical procedures are used when the blocked artery needs to be bypassed. There are several open surgery techniques used.

Renal Artery Thrombosis

Treatment of a renal artery thrombosis depends on whether the condition has a sudden onset (acute) or has developed over time (chronic), and the length of time since the thrombosis (clot) occurred. 
If the onset is acute, then medication used to break up the clot may be infused into the renal artery for several hours to several days. 
Surgical removal of the clot may be necessary in some cases.

Renal Artery Aneurysm

The type of treatment provided for a renal artery aneurysm depends on a number of factors, including size, location, and associated symptoms. 
If an aneurysm is small enough (less than three-quarters of an inch), it may be left alone and observed.

Certain aneurysms will most likely need surgery. These types include:
  • Larger aneurysms (larger than three-quarters of an inch)
  • Dissecting aneurysms
  • Aneurysms causing a lack of blood flow to the kidneys
  • Aneurysms causing hypertension
  • Aneurysms that are growing larger 
  • Aneurysms that produce symptoms
If the patient is pregnant or of childbearing age, a renal artery aneurysm will generally be surgically removed due to a higher risk of it rupturing.

Atheroembolic Renal Disease

Treatment of atheroembolic renal disease depends on the severity of the condition. While some conditions may be treated medically, other conditions may require surgery.

Medical Treatment
Medical treatment may be used to reduce or manage related medical conditions, such as diabetes. It may also be used to manage cholesterol and high blood pressure.

Surgical Treatment
Surgical treatment may include endovascular procedures or open surgery.

Endovascular Procedures
Endovascular procedures include methods to open the artery. The most common endovascular techniques are angioplasty (Endovascular Angioplasty), which uses a balloon or other method to open the blocked artery, or the placement of a stent (Endovascular Stent Repair), which is a tiny, expandable metal coil placed inside an artery to keep the artery open.

Open Surgery
Open surgical procedures are used when the blocked artery needs to be bypassed. There are several open surgery techniques used. 


Renal Vein Thrombosis

In most cases, renal vein thrombosis is treated with anticoagulant (keeps blood clots from forming) medication.