Management and Treatment of Conditions That Are Identified via Renal Artery Ultrasound
Management and treatment of conditions that are identified via renal artery ultrasound are for addressing the following:
- Renal artery atherosclerosis and stenosis resulting in occlusive disease. This creates hypoperfusion and impairs sodium excretion which expands the extracellular fluid volume, contributing to systemic hypertension.
- Suspected renal infarction as a result of arterial atherosclerotic emboli.
- Renal artery hypertension.
- Incidental findings of stony urinary tract obstruction or kidney calcifications indicating chronic renal dysfunction.
In the renal artery, these conditions all represent some type of obstruction that can be addressed in one of three ways:
- Medical therapy: Used alone or in combination to the invasive approaches (below).
- Renal angioplasty: Repair of the diseased arterial segment using a stent that can be inserted via interventional radiological techniques (percutaneously). The stent can reestablish blood flow through the diseased portion of the artery.
- Surgical revascularization
Because kidney hypoperfusion from renal artery disease sets into motion the kidney’s blood pressure maintenance mechanisms as a disadvantage, blocking this very mechanism can help address or prevent the hypertension that results. The renin-angiotensin-aldosterone system is tempered with an angiotensin-converting enzyme inhibitor (ACE inhibitor) or an angiotensin II receptor blocker (ARB) in combination with a diuretic. This is effective enough to realize a reduction in the risk of stroke or myocardial infarction that come from the kidney disease-hypertension-further kidney disease-further hypertension vicious cycle.
Percutaneous Transluminal Renal Angioplasty and Stenting
Although renovascular angioplasty can be done without stenting, the success in addressing renal artery disease is superior when stenting is incorporated into the procedure, whether there is unilateral or bilateral disease.
Compared with percutaneous stenting, the success of surgical revascularization is about the same in addressing hypertension. It is therefore relegated to those with multiple small artery disease, in need of aortic reconstruction, or who could benefit from a bypass of the renal artery to supply blood to the kidney(s).