Renal Artery Ultrasound and Prevention
Prevention of kidney impairment to excretion from hypoperfusion or the development of systemic hypertension secondary to renal artery disease (perpetuating a vicious cycle: renal artery disease engendering hypertension which furthers renal artery disease, and so on) is best addressed simultaneously for the most rational therapeutic approach.
Patients with atherosclerotic renovascular disease typically have widespread (systemic) atherosclerosis and present with a high risk for coronary artery disease. If there is bilateral disease (or unilateral disease with a single kidney), antihypertensive therapy is indicated.
ACE inhibitors and angiotensin II receptor blockers can be used to interrupt the kidneys’ reactive renin-angiotensin-aldosterone system from compensatory overreaction toward secondary hypertension which can further the actual primary renal disease. Diuretics are recommended to impact impaired excretion favorably.
Blood tests can be used to monitor electrolyte balance and prevent or treat imbalances. Serum creatinine can be measured serially to follow any progression of global renal disease upon which to determine whether invasive correction (percutaneous stenting or surgical revascularization) is warranted to eliminate or delay any life-threatening consequences of progressive disease.
Those at risk for all cardiovascular disease, specifically diabetics, should implement strict glycemic control and maintain their targeted glycated hemoglobin A1c. Smokers should quit, using medications available (e.g., Chantix) to increase the odds of success. Patients with unacceptable cholesterol and/or triglyceride levels should be placed on statin drugs to correct these abnormalities in their lipids.
At some point, which is individualized for the patient and by physician preference and experience, more invasive remedies may be indicated, especially with the inherent connection to other atherosclerotic complications such as coronary artery disease and its risk of stroke and myocardial infarction.