What is renal artery stenosis?

Renal artery stenosis is where the arteries which carry blood to your kidneys become narrowed. This can harm the functioning of your kidneys and lead to high blood pressure. Renal artery stenosis can occur due to growth in the muscles of the arteries or atherosclerosis.

Renal artery stenosis procedures are aimed at restoring the flow of blood in the kidneys and avoid deteriorating kidney function, but in fact rarely needed. Left untreated, however, renal artery stenosis can cause a patient to lose kidney function to such a degree they require dialysis or a kidney transplant.

What is the first line of treatment?

Treatment usually involves tablets and lifestyle changes to lower blood pressure. This is very important and most people need 3 or more medicines to get the blood pressure less than 130/80 mmHg. You almost certainly will also need aggressive lowering of blood fats (cholesterol) with a statin as well as a careful diet, and usually also aspirin. These treatments stop the arteries getting more narrowed, and stops blood clotting in them. 

Why might surgery for renal artery stenosis be needed?

Renal artery stenosis surgery is not the first line of treatment. In many cases, renal artery stenosis can be managed with lifestyle changes, to prevent further build up fatty acids in the arteries, to help relax the blood vessels.

Surgery is only considered if:

• you have uncontrolled high blood pressure
• your kidney function is deteriorating rapidly
• if you suffer a complication such as pulmonary oedema (build up of fluid in the lungs)

What does renal artery stenosis surgery involve?

Usually there is no surgery at all, but rather "balloon angioplasty", when the artery is opened up by passing a balloon from the artery in the top of the leg into the kidneys, and usually also inserting a stent (a small metal tube which keeps the artery open) at the same time Very very rarely an open operation is done, but this is exceedingly rare: renal artery bypass surgery aims to create a new route for the blood to flow through by grafting a new blood vessel onto the renal artery. 

How can I prepare for renal artery stenosis angioplasty (or surgery)?

Before surgery, you are likely to have a number of medical examinations, including blood tests, to determine your overall state of health and readiness for surgery. You will also be taking blood pressure medicines and statins, and these will likely continue after. You should be as fit as possible, have been exercising, eating a healthy diet and stopped smoking.

Care after angioplasty (or surgery)

Angioplasty is usually a day case procedure but you may need to stay in hospital overnight. You blood pressure will be monitored, and you will need repeat blood testing a few weeks after the angioplasty, and have ongoing care in an outpatient clinic. You will need to continue various medicines. You will be advised on the lifestyle changes required to keep your blood pressure under control and avoid further renal artery narrowing.

After an operation, you will be monitored for a period of time in hospital to check if any complications arise and deal with the promptly if they do. The specialist may schedule a number of follow-up appointments to monitor the blood flow in your kidneys and overall blood pressure.