[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Renovascular hypertension (renal artery stenosis) [Conditions](https://durgical.com/en/conditions/) · [Nephrology and urology](https://durgical.com/en/conditions/) # Renovascular hypertension (renal artery stenosis) A narrowing of the artery to one or both kidneys. The kidney senses low flow and raises blood pressure, which can become hard to control. Updated 2026-11-01 ## Structures involved Tap one to see what it is and open it in 3D. - [Right renal artery](https://durgical.com/en/anatomy/renal-artery-abdomen/) - [Left renal artery](https://durgical.com/en/anatomy/renal-artery/) - [Kidneys](https://durgical.com/en/anatomy/kidney/) - [Abdominal aorta](https://durgical.com/en/anatomy/abdominal-aorta/) - [Vessels inside the kidney](https://durgical.com/en/anatomy/intrarenal-arteries-and-veins/) - [Right adrenal gland](https://durgical.com/en/anatomy/suprarenal-gland-abdomen/) - [Left adrenal gland](https://durgical.com/en/anatomy/suprarenal-gland/) ## In the clinical exam - [Hypertensive emergency: target-organ signs](https://durgical.com/en/clinical-exam/hypertensive-emergency-target-organ-signs/) ## Why it happens - [The renin–angiotensin–aldosterone system](https://durgical.com/en/physiology/the-renin-angiotensin-aldosterone-system/) - [Long-term blood pressure control by the kidney](https://durgical.com/en/physiology/long-term-blood-pressure-control-by-the-kidney/) - [Physiology of hypertension](https://durgical.com/en/physiology/physiology-of-hypertension/) - [Renal blood flow, autoregulation and tubuloglomerular feedback](https://durgical.com/en/physiology/renal-blood-flow-autoregulation-and-tubuloglomerular-feedback/) - [Angiotensin-converting enzyme (ACE)](https://durgical.com/en/biochemistry/enzymes/angiotensin-converting-enzyme/) ## What it is Narrowing of one or both renal arteries that reduces blood flow to the kidney. It is a potentially curable cause of secondary hypertension (kidney parenchymal disease is the most common secondary cause) and can also cause ischaemic kidney disease. ## Who gets it Atherosclerotic disease is the usual form in older adults with vascular risk factors; fibromuscular dysplasia mostly affects women under 50. It is an important cause to consider in Latin America given the high burden of hypertension, diabetes and smoking. ## Causes - Atherosclerosis at the origin of the [renal artery](https://durgical.com/en/anatomy/renal-artery/) (most cases, older adults) - Fibromuscular dysplasia: a non-inflammatory wall disease with a "string of beads" appearance, in the middle or distal artery (young women) - Less often: vasculitis such as Takayasu arteritis, dissection, external compression or thrombosis ## Risk factors - Older age, smoking, diabetes and dyslipidaemia - Coronary, carotid or peripheral artery disease - Female sex and younger age for fibromuscular dysplasia - Heavy alcohol or cocaine use ## Pathophysiology Low pressure beyond the narrowing is sensed by the juxtaglomerular cells, which release renin. Angiotensin II constricts vessels and aldosterone retains sodium and water, so blood pressure rises (high-renin hypertension), often with low potassium. In bilateral disease or a single kidney, glomerular filtration depends on angiotensin II, which explains the fall in function with ACE inhibitors or ARBs. ## Classification - By cause: atherosclerotic or fibromuscular dysplasia - Unilateral or bilateral (or stenosis of a solitary kidney) - Haemodynamically significant or not ## Symptoms and signs - Often no symptoms apart from high blood pressure - Hypertension starting before 30 (especially without family history) or after 55 - Resistant hypertension despite three drugs including a diuretic - Sudden worsening of previously controlled blood pressure - Abdominal or flank bruit - Unexplained decline in kidney function or a small kidney on one side ## Red flags - Sudden ("flash") pulmonary oedema with hypertension - A creatinine rise of 30% or more after starting an ACE inhibitor or ARB - Hypertensive emergency with target-organ damage - Rapidly worsening kidney function ## Diagnosis **Clinical** Suspect it in hypertension with typical clues: age of onset, resistance, flash pulmonary oedema, abdominal bruit, [kidney](https://durgical.com/en/anatomy/kidney/) asymmetry or a fall in function after ACE inhibitors or ARBs. **Tests** Creatinine and eGFR, potassium (often low), urinalysis and urine albumin; plasma renin and aldosterone may be high. Renal function is rechecked after starting renin–angiotensin blockers. **Imaging** Doppler (duplex) ultrasound of the renal arteries as a first non-invasive test; CT or MR angiography. Catheter angiography is the reference standard and is done when intervention is planned. ## Differential diagnosis - Essential (primary) hypertension - Primary hyperaldosteronism - Chronic kidney parenchymal disease - Pheochromocytoma - Coarctation of the aorta - Obstructive sleep apnoea or drug-induced hypertension ## Goal of treatment Control blood pressure, preserve kidney function and reduce cardiovascular risk; revascularise selected patients who benefit. ## Treatment **Lifestyle** Stopping smoking, salt reduction, a heart-healthy diet, physical activity and limiting alcohol. **Medical** Antihypertensive drugs, often including ACE inhibitors or ARBs with close monitoring of creatinine and potassium (caution in bilateral disease or a single kidney); calcium-channel blockers and diuretics as needed. **Medical** Atherosclerotic disease: statins and, usually, antiplatelet therapy, plus control of diabetes. **Procedure** Angioplasty, with a stent for atherosclerotic lesions, is first choice in fibromuscular dysplasia and reserved in atherosclerosis for flash pulmonary oedema, refractory hypertension or progressive kidney loss. **Follow-up** Regular blood pressure, creatinine and potassium checks; imaging follow-up after revascularisation. ## Complications - Ischaemic nephropathy and chronic kidney disease - Acute kidney injury with ACE inhibitors or ARBs in bilateral disease - Flash pulmonary oedema and heart failure - Stroke and myocardial infarction - Hypertensive retinopathy ## Prognosis Fibromuscular dysplasia responds well to angioplasty and blood pressure often improves or normalises. In atherosclerotic disease, outcome is driven by overall cardiovascular disease; medical therapy is the mainstay because routine stenting has not shown better results than optimal drug treatment. ## Prevention - Control of atherosclerotic risk factors: not smoking, blood pressure, glucose and lipids ## Test yourself Think of the answer, then tap the question to see it. ## What are the two main causes of renal artery stenosis and whom does each affect? Atherosclerosis in older adults with vascular risk factors, and fibromuscular dysplasia in young women. ## What is the classic angiographic appearance of fibromuscular dysplasia? A "string of beads" in the middle or distal renal artery. ## Why can creatinine rise sharply after an ACE inhibitor in bilateral stenosis? Filtration depends on angiotensin II constricting the efferent arteriole; blocking it drops glomerular pressure. ## Which non-invasive test is usually the first to screen for it? Doppler (duplex) ultrasound of the renal arteries, with CT or MR angiography as alternatives. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/renovascular-hypertension/) ## Related conditions - [Arterial hypertension](https://durgical.com/en/conditions/arterial-hypertension/) - [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/) - [Acute kidney injury](https://durgical.com/en/conditions/acute-kidney-injury/) - [Atherosclerosis and dyslipidaemia](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/) - [Peripheral artery disease](https://durgical.com/en/conditions/peripheral-artery-disease/) - [Abdominal aortic aneurysm](https://durgical.com/en/conditions/abdominal-aortic-aneurysm/) - [Primary hyperaldosteronism (Conn syndrome)](https://durgical.com/en/conditions/primary-hyperaldosteronism/) - [Heart failure](https://durgical.com/en/conditions/heart-failure/) - [Hypokalaemia](https://durgical.com/en/conditions/hypokalaemia/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Renal Artery Stenosis](https://www.niddk.nih.gov/health-information/kidney-disease/renal-artery-stenosis) (NIDDK (National Institutes of Health), 2024); [Renovascular hypertension: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000204.htm) (MedlinePlus (U.S. National Library of Medicine), 2024); Harrison's Principles of Internal Medicine, 21st ed., ch. 277 Hypertension (McGraw Hill, 2022). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/renovascular-hypertension/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/renovascular-hypertension/