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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The decision whether to treat renal artery stenosis with medicine or with a surgical procedure depends on the situation.

In patients with renal artery stenosis and only one kidney, if kidney failure from renal artery stenosis is a possibility, opening the artery with a surgical procedure may be the preferred option. Similarly, if there is significant stenosis in both renal arteries and kidney function is compromised, surgical repair may be offered as the primary treatment.

If the renal artery stenosis causes less than 50% narrowing of the artery and if kidney function is maintained, medications that block the actions of angiotensin [for example, captopril (Capoten), enalapril (Vasotec), losartan (Cozaar)] may be used in association with routine monitoring of the renal artery status with ultrasound.

The most frequently used invasive procedure to open a narrowed renal artery uses the same type of procedure that is used in heart disease. Balloon angioplasty allows a radiologist to insert a catheter, or narrow tube, into the femoral artery in the groin and advance it to the area of narrowing in the renal artery. By quickly inflating the balloon, the cholesterol plaque causing the narrowing is compressed into the artery wall. A stent or wire mesh is then placed across the area of previous narrowing to keep it open.

If angioplasty fails or is not technically feasible, formal bypass surgery may be considered. In this situation, just like in a heart bypass operation, a surgeon will take a piece of normal vein or a synthetic tube and connect the aorta and kidney, bypassing the blocked area.

Unfortunately, if the renal artery stenosis is longstanding and kidney function has been compromised for a prolonged period of time, return blood flow to the kidney may not return kidney function.

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