[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Kidney](https://durgical.com/en/general-pathology/areas/kidney/) › Renal artery stenosis

# Renal artery stenosis

- Lesion

A narrowed renal artery makes the kidney release renin, raising blood pressure; the kidney behind it shrinks.

Updated Nov 12, 2026

## Key points

- Atherosclerosis: ostial or proximal plaque, older men, smokers, diabetics, with disease elsewhere.
- Fibromuscular dysplasia: medial fibroplasia with a string-of-beads image, mid or distal artery, young women.
- Ischemic kidney: small, with crowded glomeruli, atrophic tubules and interstitial fibrosis; arterioles protected from high pressure.
- Hyperplastic juxtaglomerular cells with more renin granules.
- ACE inhibitors and ARBs can drop GFR sharply in bilateral stenosis.

## What it is

Renal artery stenosis causes a small but curable share of hypertension. Reduced pressure at the juxtaglomerular apparatus switches on the renin-angiotensin-aldosterone system, as in Goldblatt's experiments. Most cases are atherosclerotic plaques at the origin of the artery in older people; the rest are fibromuscular dysplasia, mostly in young women. Bilateral or solitary-kidney stenosis can also cause ischemic nephropathy, a slow loss of function.

## Structure

- The affected kidney is smaller; glomeruli lie close together because tubules have atrophied.
- Its arterioles show little hyalinosis because they are shielded from systemic pressure, while the opposite kidney shows hypertensive damage.
- Fibromuscular dysplasia: ridges of thickened media alternating with thinned segments and small aneurysms.

## Two causes of renal artery stenosis

| Cause | Who | Lesion | Site |
| --- | --- | --- | --- |
| [Atherosclerotic stenosis](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/) | About two thirds of cases; older adults, more often men | Plaque narrowing the lumen | Origin and first part of the artery |
| Fibromuscular dysplasia | Young women | Fibrous and muscular thickening of the media, with small aneurysms | Middle and distal artery; carotids may also be involved |

## Clinical notes

- Suspect it in severe or resistant hypertension, sudden onset before 30 or after 55, an abdominal bruit, or a rise in creatinine after starting ACE inhibitors.
- Atherosclerotic ischemic renal disease often coexists with coronary and peripheral artery disease.

## Memory aid

Old man, plaque at the gate; young woman, beads along the road.

## Test yourself

Think of the answer, then tap the question to see it.

## How does renal artery stenosis raise blood pressure?

Lower perfusion pressure at the juxtaglomerular apparatus stimulates renin release, activating angiotensin II and aldosterone.

## What angiographic image is typical of fibromuscular dysplasia?

A string of beads: alternating narrowings and dilatations of the mid or distal renal artery.

## Why does the stenotic kidney show little arteriolar hyalinosis?

Its arterioles are protected from the high systemic pressure by the upstream narrowing.

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## Elsewhere in DurgiPedia

- [Long-term blood pressure control by the kidney](https://durgical.com/en/physiology/long-term-blood-pressure-control-by-the-kidney/)
- [Atrophy](https://durgical.com/en/general-pathology/atrophy/)

## Connections

## Related 5

- [Hypertensive nephrosclerosis: benign vs malignant](https://durgical.com/en/general-pathology/hypertensive-nephrosclerosis-benign-vs-malignant/)
- [Renal emboli, infarcts and sickle cell nephropathy](https://durgical.com/en/general-pathology/renal-emboli-infarcts-and-sickle-cell-nephropathy/)
- [Consequences of atherosclerosis](https://durgical.com/en/general-pathology/consequences-of-atherosclerosis/)
- [Hypertension: mechanisms](https://durgical.com/en/general-pathology/hypertension-mechanisms/)
- [Atrophy](https://durgical.com/en/general-pathology/atrophy/)

## Related conditions 4

- [Renovascular hypertension (renal artery stenosis)](https://durgical.com/en/conditions/renovascular-hypertension/)
- [Arterial hypertension](https://durgical.com/en/conditions/arterial-hypertension/)
- [Atherosclerosis and dyslipidaemia](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/)
- [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Renovascular hypertension: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000204.htm) (MedlinePlus, US National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/renal-artery-stenosis/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/renal-artery-stenosis/