genitourinary disorders
Renal Artery Stenosis and Occlusion
Key Points
Renal artery stenosis or occlusion may be acute (usually due to thromboembolism) or chronic (usually due to atherosclerosis or fibromuscular dysplasia). Suspect acute occlusion if patients have steady, aching flank or abdominal pain, and sometimes fever, nausea and vomiting, and/or gross hematuria. Suspect chronic occlusion in patients who develop unexplained severe or early-onset hypertension. Confirm the diagnosis with vascular imaging. Restore vascular patency for patients who have acute occlusion and for selected patients (eg, with severe complications or refractory disease) who have chronic occlusion. ACE inhibitors and ARBs are effective for hypertension control in patients with renovascular hypertension, but additional antihypertensive medications are frequently required. 