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atheroembolic renal disease Images (Click to view larger image)
Alternative Names
atherosclerotic renal vascular disease, renal artery embolism, cholesterol embolism, renal artery aneurysm
Definition
Atheroembolic renal disease is one in which the kidneys fail because the arteries that supply them with oxygen- and nutrient-rich blood become blocked.
What is going on in the body?
Blockage in the renal arteries can be caused by: - a build-up of a fatty substance called plaque due to a condition called arteriosclerosis
- a blood or cholesterol clot, called an embolism, that becomes stuck in the blood vessel
- a bulging in the wall of the blood vessel, usually due to plaque build-up or high blood pressure which is called an aneurysm
What are the signs and symptoms of the disease?
Depending on what causes the blocked artery, symptoms can include: - high blood pressure
- pain in the back between the ribs and the hips
- blood in the urine
- low blood pressure which is rare
Blood or cholesterol clots usually cause sudden, sharp pain in the lower back between the ribs and hips. Sometimes there is also stomach pain or nausea.
What are the causes and risks of the disease?
Plaque build-up can be caused by: - high blood pressure
- smoking
- diabetes
- excessive levels of fat in the blood, which may be related to diet or genetic make up
Blood clots can be caused by: - plaque build-up
- coronary artery disease
- heart valve disease
- arrhythmias, which are irregular heartbeats
Cholesterol clots can be caused by: - plaque build-up
- complications from angiography, which is an X-ray of the inside of the heart and blood vessels, medication used to break up clots, or vascular surgery
Aneurysms can be formed by: - trauma to the blood vessel, such as surgery or a gunshot wound
- long-standing high blood pressure
- plaque build-up
- poorly understood genetic factors
What can be done to prevent the disease?
To prevent this disease, a person should: - control his or her blood pressure
- control his or her diabetes
- have his or her cholesterol checked regularly
- eat a low-fat diet
- exercise regularly
- not smoke or stop smoking
How is the disease diagnosed?
A doctor may suspect that a person with high blood pressure has plaque build-up in the renal artery if: - there is no family history of high blood pressure
- high blood pressure begins when the person is older than 45
- high blood pressure begins suddenly, or becomes increasingly difficult to control, or is accompanied by a headache
Screening tests used to confirm the diagnosis can include: - blood tests
- nuclear medication kidney scans with or without the use of the high blood pressure drug, captopril
- duplex ultrasound
The definitive diagnosis is made using renal angiography. This involves placing a catheter through an artery in the groin, which is threaded up to the renal artery. Dye is injected to allow the doctor to see the inside of the artery. This test is also used to confirm the presence of aneurysms and blood or cholesterol clots.
What are the long-term effects of the disease?
Long-standing and uncontrolled high blood pressure can cause serious heart and blood vessel problems.
Haemodialysis is a procedure that does the work of the kidneys by cleaning the waste and impurities from the blood. This procedure may be needed if the kidneys fail completely.
Blood clots can rupture, causing dramatic blood loss, shock, and even death.
What are the risks to others?
There are no risks to others from this disease.
What are the treatments for the disease?
Plaque build-up that causes high blood pressure is often treated with medication. If this doesn't work, doctors may try: - angioplasty, a non-surgical procedure that is done the same way as angiography described above. When the doctor gets to the blockage, a special tube is inflated, flattening the plaque against the artery wall. This opens the artery for blood to flow through.)
- surgery to remove the plaque from the artery.
- surgery to reconstruct the artery.
- surgery to replace the artery with an artificial graft.
A renal artery aneurysm is only treated if it is larger than 1.5 centimetres, roughly 1/2 inch, or if it is causing very high blood pressure. If the aneurysm is in a small branch of the renal artery, then this branch may be removed. This will cause loss of that small portion of the kidney, but will prevent other problems. Other renal artery aneurysms may require surgery.
Doctors first try to treat blood clots with a thrombolytic medication to break down blood clots, such as streptokinase or urokinase. If this doesn't work, surgery to remove the clot or the kidney may be needed.
What are the side effects of the treatments?
Renal artery angioplasty has a complication rate of about 10%. The most common problems include persistent bleeding or an infection at the site of access in the groin artery. Kidney damage can occur, but is rare.
Aside from the usual problems in surgery, such as wound infections and pneumonia, renal artery surgery can cause bleeding or clotting of the operated artery.
Thrombolytic medications can cause bleeding, as well as local groin artery problems.
What happens after treatment for the disease?
This varies depending on the treatment, but most patients will be able to resume their normal activities shortly after any procedure or surgery. Follow-up instructions will be provided.
How is the disease monitored?
After treatment, control of high blood pressure, high cholesterol and diabetes is required if these are present. Exercising and eating a healthy diet, and stopping smoking, are also important. Monitoring of these conditions is done in all patients and specific additional monitoring depends on the treatment used and individual patient circumstances.
Author: Stuart Wolf, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 19/06/2005
Contributors
Potential conflict of interest information for reviewers available on request |
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