Renovascular Hypertension – Symptoms, Causes & Treatment

Renovascular hypertension is a form of secondary high blood pressure caused by the narrowing (stenosis) or blockage of one or both renal arteries, the blood vessels that supply the kidneys. This condition results in reducing the blood flow to the kidneys, prompting them to release hormones such as renin, which leads to increased blood pressure throughout the body. 

The most common underlying causes are atherosclerosis (plaque buildup in the arteries) and fibromuscular dysplasia (abnormal cell growth in the artery walls). Left untreated, renovascular hypertension can lead to chronic kidney disease and other serious cardiovascular complications.

Key Indicators of Renovascular Hypertension

• Sudden onset of high blood pressure before age 30 or after age 55
• Severe or resistant hypertension that doesn't respond to standard treatment
• High blood pressure with no family history
• Worsening kidney function after starting blood pressure medications
• Unexplained kidney shrinkage (one kidney smaller than the other)
• Flash pulmonary edema (sudden fluid buildup in the lungs)
• Abdominal bruit (whooshing sound heard over the kidneys)
• Episodes of vision problems or headaches
• Elevated blood urea nitrogen (BUN) and creatinine levels

Primary Triggers Behind Renovascular Hypertension

• Atherosclerosis (constricting of the renal arteries due to plaque buildup)
• Fibromuscular dysplasia (abnormal growth of cells in the artery walls)
• Renal artery aneurysm
• Renal artery embolism or thrombosis
• Vasculitis affecting renal arteries
• External compression of the renal artery (e.g., tumor or fibrotic tissue)
• Post-transplant renal artery stenosis
• Congenital defects in renal artery structure

Diagnostic Measures for Renovascular Hypertension

• Blood Pressure Monitoring: Persistent or severe hypertension despite standard treatment prompts further investigation.
• Serum Creatinine and BUN Tests: Elevated levels may indicate impaired kidney function linked to reduced blood flow.
• Renin and Aldosterone Levels: A high plasma renin activity level, especially when paired with elevated aldosterone, supports suspicion of renovascular origin.
• Urinalysis: May show signs of kidney stress or damage, though it is often nonspecific in this condition.
• Renal Duplex Ultrasound: Non-invasive imaging to assess blood flow and detect narrowing in the renal arteries.
• CT Angiography (CTA): High-resolution imaging of renal vessels using contrast dye to identify stenosis or blockages.
• Magnetic Resonance Angiography (MRA): Uses magnetic fields and contrast to visualize blood flow in the renal arteries, beneficial for patients who can't tolerate iodine-based contrast.
• Captopril Renography: Nuclear scan that evaluates kidney function before and after administration of captopril to detect functional differences due to narrowed arteries.
• Digital Subtraction Angiography (DSA): Considered the gold standard for diagnosing renal artery stenosis; provides detailed images and allows for possible simultaneous intervention.

Treatment Options for Renovascular Hypertension

• Angioplasty: A catheter-based procedure where a balloon is inflated at the site of arterial narrowing to restore blood flow to the kidney.
• Stent Placement: Often performed along with angioplasty, a stent (a small tube) is inserted to keep the artery open and prevent re-narrowing.
• Surgical Revascularization: Involves bypassing the blocked section of the renal artery or reconstructing the artery to restore normal blood flow. Typically considered when less invasive procedures fail or are not suitable.
• Nephrectomy (in select cases): Surgical removal of the affected kidney may be necessary if it’s non-functional and contributing to uncontrolled hypertension.
• Endarterectomy: Surgically getting rid of the inner lining of the artery if plaque buildup is extensive, usually performed in large or complex lesions.

Approaches to Managing Renovascular Hypertension

• Blood Pressure Control: Initial treatment focuses on controlling blood pressure to reduce cardiovascular and renal risks, using tailored combinations based on kidney function.
• Lifestyle Modifications: Includes dietary changes (low sodium, balanced nutrition), regular physical activity, smoking cessation, and weight management to support blood pressure control.
• Monitoring Kidney Function: Regular assessment of kidney performance to detect deterioration early and adjust management accordingly.
• Percutaneous Transluminal Renal Angioplasty (PTRA): A procedure where a balloon is used to open narrowed renal arteries, often followed by stent placement if needed.
• Surgical Revascularization: Reserved for cases where angioplasty is unsuccessful or not feasible; involves bypassing or repairing the narrowed segment of the artery.
• Dialysis (if required): Initiated in cases of advanced kidney failure unresponsive to revascularization or medical management.

Long-Term Outlook for Renovascular Hypertension

The outcome depends on the cause, severity of arterial narrowing, and how early the condition is diagnosed. If identified and treated early, especially in cases of fibromuscular dysplasia, blood pressure may return to normal or become easier to control. 

Atherosclerotic cases often require long-term monitoring, and full normalization of blood pressure may not always be achievable. Delayed treatment increases the risk of chronic kidney disease and cardiovascular complications. Regular follow-ups, adequate blood pressure control, and kidney function monitoring are essential to prevent long-term damage.

Sterling Hospital is Your Partner in Better Health Across Gujarat

At Sterling Hospital, we provide you with the utmost care and comfort throughout your journey to healthy kidneys. If you are looking for the best kidney specialist in Ahmedabad and Vadodara Race Course Road, Vadodara Bhayli, we've got you. 

With considerable years of experience, we have built a team of the best nephrologists in these regions to provide you with premium treatment and the best results. Safeguard your kidney health and contact Sterling Hospital to schedule a consultation and embark on a journey towards a healthier life.