Medical expert of the article
New publications
Renal artery stenosis - Treatment
Last reviewed: 04.07.2025

All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Treatment for renal artery stenosis (ischemic kidney disease) consists of the following:
- minimizing the number of medications used (if possible, eliminating NSAIDs, antibacterial and antifungal drugs);
- prescribing statins (possibly in combination with ezetimibe);
- discontinuation of ACE inhibitors and angiotensin II receptor blockers;
- optimization of the diuretic regimen (prevention of forced diuresis);
- if possible, early use of invasive treatment methods.
The prospects of antihypertensive therapy in atherosclerotic renal artery stenosis are limited by the impossibility of using ACE inhibitors and angiotensin II receptor blockers (even in absolute indications, such as chronic heart failure or type 2 diabetes mellitus) and thiazide diuretics, which lose their effectiveness with a persistent decrease in SCF. All patients with ischemic kidney disease, however, require combined antihypertensive therapy. Long-acting calcium channel blockers in combination with cardioselective beta-blockers, P-imidazoline receptor agonists, alpha-blockers and loop diuretics can be used as basic drugs. A sharp decrease in blood pressure is undesirable; titration of antihypertensive drug doses should be performed under control of serum creatinine and potassium levels. Achieving the general population target blood pressure (<140/90 mmHg) in atherosclerotic renal artery stenosis may be dangerous due to worsening renal tissue hypoperfusion.
Statins are absolutely indicated for all patients with ischemic kidney disease. In case of severe lipoprotein metabolism disorders (for example, in case of hypercholesterolemia and hypertriglyceridemia), their combination with ezetimibe is possible. Drug correction of other metabolic disorders is mandatory: insulin resistance and type 2 diabetes mellitus, hyperuricemia; its tactics are limited by the need to change the doses of most drugs (for example, allopurinol), based on the degree of decrease in SCF.
Active prevention of cardiovascular complications in atherosclerotic renal artery stenosis involves the administration of acetylsalicylic acid and/or clopidogrel. Their use regimens apparently do not differ from those generally accepted for coronary heart disease, but require special study in patients with atherosclerotic renovascular hypertension from the point of view of safety.
Conservative treatment of renal artery stenosis is always ineffective, since it does not allow for either control over blood pressure or stabilization of renal function. This is why early renal revascularization is justified, although most patients experience a decrease, but not normalization, in blood pressure and creatininemia. Balloon dilation of the renal arteries is quickly accompanied by restenosis, and therefore stent implantation is always justified. The risk of in-stent restenosis is increased by initially high systolic blood pressure, severe hypercreatininemia, old age, and hyperfibrinogenemia. The advantage of rapamycin-eluting stents in atherosclerotic renal artery stenosis, as opposed to ischemic heart disease, has not yet been proven. Renal artery bypass grafting is performed when stenting is impossible or previously performed stenting is ineffective; This intervention can be complicated by the presence of concomitant diseases, including cardiovascular diseases.
Angioplasty is the only treatment method that reliably improves the prognosis for atherosclerotic renal artery stenosis; after its implementation, patients, however, continue to require aggressive secondary prevention of cardiovascular complications, which apparently also reduces the likelihood of in-stent restenosis. Optimal tactics for prescribing antiplatelet agents (including platelet receptor blockers IIb/IIIa and clopidogrel) and anticoagulants (including low-molecular-weight heparins) in the immediate period after intervention on the renal arteries requires further clarification and cannot be completely borrowed from the generally accepted tactics for coronary artery disease.
Approaches to the treatment of cholesterol embolism of intrarenal arteries and arterioles have not been developed. The severity of acute renal failure may require emergency hemodialysis. Apparently, statins are indicated, and in case of pronounced immunoinflammatory manifestations (including acute eosinophilic tubulointerstitial nephritis) - corticosteroids in high doses. The effectiveness of the above methods of treating renal artery stenosis has not been studied in controlled clinical trials.
In the case of terminal renal failure, programmed hemodialysis or continuous outpatient PD is started. Kidney transplantation is not performed in case of atherosclerotic stenosis of the renal arteries. Therapeutic nephrectomy should be considered only in case of established renal atrophy and the impossibility of reducing blood pressure with medications and/or in case of acquisition of arterial hypertension with features of malignancy.