Conditions & Treatments

Renal Vascular Disease

Renal vascular disease is the name given to a variety of complications that affect the arteries and veins of the kidneys.

Renal Vascular Disease

What is renal vascular disease?

Renal vascular disease is the name given to a variety of complications that affect the arteries and veins of the kidneys. These complications affect the blood circulation of the kidneys, and may cause damage to the tissues of the kidneys, kidney failure, and/or high blood pressure.

Vascular conditions affecting the renal arteries and veins include the following:

  • Renal artery stenosis. Renal artery stenosis (RAS) is a blockage of an artery to the kidneys. It may cause kidney failure and hypertension (high blood pressure). Smokers have a greater risk of developing RAS. RAS is most common in men between the ages of 50 and 70. High cholesterol, diabetes, being overweight, and having a family history of cardiovascular disease are also risk factors for RAS. High blood pressure is both a cause and a result of RAS.

  • Renal artery thrombosis. Renal artery thrombosis is the formation of a clot in a renal artery. A thrombosis of a renal artery may cause kidney failure because of blocked blood flow to the kidney.

  • Renal artery aneurysm. A renal artery aneurysm is a bulging, weakened area in the wall of an artery to the kidney. Most of these aneurysms are small (less than two centimeters, or about three-quarters of an inch) and without symptoms. Renal artery aneurysms are uncommon and are generally discovered during diagnostic procedures performed in relation to other conditions.

  • Atheroembolic renal disease. Atheroembolic renal disease occurs when a piece of plaque from the aorta and/or other large arteries breaks off and travels through the bloodstream, blocking small arteries such as the renal arteries. Atheroembolic renal disease is becoming a common cause of renal insufficiency (poor kidney function) in the elderly.

  • Renal vein thrombosis. A renal vein thrombosis is the formation of a clot in a vein to the kidney.

Renal vascular disease is often associated with hypertension (high blood pressure). Hormones that influence blood pressure are affected by kidney function. Decreased blood flow to the kidney(s) as a result of renal vascular disease may cause an excessive amount of renin to be produced. Renin is a powerful hormone that increases blood pressure.

What causes renal vascular disease?

Illustration of the anatomy of the kidney
Click Image to Enlarge

The cause of renal vascular disease will depend on the specific condition involved:

  • Renal artery stenosis. Stenosis (blockage) of a renal artery may be caused by atherosclerosis (a buildup of plaque, which is a deposit of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of an artery) or other conditions, such as fibromuscular dysplasia (a condition that weakens the walls of medium-sized arteries and occurs predominantly in young women of childbearing age), and Takayasu's arteritis (a rare inflammatory disease affecting the aorta and its branches, including the renal arteries). Atherosclerosis is the major cause of renal artery stenosis in the U.S.

  • Renal artery thrombosis. Formation of a thrombosis (clot) inside one of the renal arteries may occur as a result of trauma, infection, inflammatory disease, renal artery aneurysm, renal cell cancer, or fibromuscular dysplasia.

  • Renal artery aneurysm. There are four types of renal artery aneurysms:

    • Saccular. These bulge or balloon out on only one side of the artery.

    • Fusiform. These bulge or balloon out on all sides of the artery.

    • Dissecting. This type is a weakened artery wall due to a tear in the inner layer of the artery wall.

    • Intrarenal. These occur on an artery inside the kidney.

    Saccular aneurysms may occur as a result of a congenital (present at birth) weakness of an artery wall or trauma. Atherosclerosis may also be a factor. Fusiform aneurysms most often occur with fibromuscular dysplasia. Intrarenal aneurysms may be congenital, or may result from trauma.

  • Atheroembolic renal disease. Small pieces of plaque (emboli) from atherosclerosis formation in other arteries of the body may break off and travel to the renal arteries, blocking blood flow to the kidney. Emboli may occur because of surgery, insertion of a catheter, or the use of blood-thinning medications. The disease most commonly affects older people.

  • Renal vein thrombosis. Conditions associated with the presence of renal vein thrombosis include trauma, compression of a renal vein by an adjacent structure, such as a tumor or aneurysm, nephrotic syndrome (results from damage to the kidneys' glomeruli, the tiny blood vessels that filter waste and excess water from the blood and send them to the bladder as urine), pregnancy, administration of steroid medications, and use of oral contraceptives (birth control pills).

Risk factors for renal vascular disease include:

  • Age

  • Female gender

  • Atherosclerosis

  • Hypertension, particularly new onset of hypertension in an older person

  • Smoking

  • High cholesterol

  • Diabetes

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking or diet, family history, or many other things. Different diseases have different risk factors.

Although these risk factors increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. Knowing your risk factors for any disease can help to guide you to the appropriate actions, including changing behaviors and being clinically monitored for the disease.

What are the symptoms of renal vascular disease?

Symptoms of renal vascular disease vary depending on the type of disease and degree of involvement present. Symptoms of various types of renal vascular disease include, but are not limited to, the following:

Type of renal vascular disease

Symptoms

Renal artery stenosis

  • Sudden onset of hypertension before age 50 suggests fibromuscular dysplasia-related stenosis

  • Sudden onset of hypertension at or after age 50 suggests stenosis caused by atherosclerosis.

  • Hypertension not responsive to three or more blood pressure medications.

  • Increased urea (a waste product excreted by the kidneys) in the blood.

  • Unexplained kidney failure.

  • Sudden kidney failure when first taking an angiotensin-converting enzyme (ACE) inhibitor medication for blood pressure and/or heart treatment

Renal artery thrombosis

Acute (sudden) complete blockage:

  • Sudden onset of flank (between the ribs and the upper border of the hip bone) pain and tenderness

  • Fever

  • Blood in the urine

  • Nausea and/or vomiting

  • Sudden decrease in kidney function

  • Hypertension

More gradual or incomplete blockages:

  • May be asymptomatic (without symptoms) and go undetected

Renal artery aneurysm

  • Generally asymptomatic

  • Hypertension may be present in up to 90 percent of persons with a renal artery aneurysm

  • Dissecting aneurysms (caused by a tear in the inner layer of the artery wall) may cause flank pain and blood in the urine

Atheroembolic renal disease

  • Skin lesions such as purpura (a type of rash in which blood cells leak into the skin or mucous membranes)

  • Mottling (discolored areas) of the toes and feet

  • Kidney failure (either sudden or occurring over a longer period of time)

  • Abdominal pain

  • Diarrhea

  • Confusion

  • Weight loss

  • Fever

  • Muscle aches

Renal vein thrombosis

Chronic (over a period of time) onset:

  • Most often asymptomatic

Acute (sudden) onset:

  • Persistent severe flank pain that may be spasmodic (with spasms) at times

  • Soreness in the area over the kidney, between the ribs and the backbone

  • Decreased kidney function

The symptoms of renal vascular disease may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is renal vascular disease diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for renal vascular disease may include any, or a combination of, the following:

  • Arteriogram (also called an angiogram). An X-ray image of the blood vessels used to evaluate various conditions, such as aneurysm, stenosis (narrowing of the blood vessel), or blockages. A dye (contrast) will be injected through a thin, flexible tube placed in an artery. This dye makes the blood vessels visible on X-ray.

  • Duplex ultrasound. A type of vascular ultrasound procedure performed to assess blood flow and the structure of the leg veins. The term duplex"refers to the fact that two modes of ultrasound are used--Doppler and B-mode. The B-mode transducer (like a microphone) obtains an image of the carotid artery being studied. The Doppler probe within the transducer evaluates the velocity and direction of blood flow in the vessel.

  • Renography. A specialized radiology procedure used to assess the function and structure of the kidneys. Renography is a type of nuclear radiology procedure. This means that a tiny amount of a radioactive substance is used during the procedure to assist in the examination of the kidneys.

  • Magnetic resonance angiography (MRA). A noninvasive diagnostic procedure that uses a combination of magnetic resonance imaging (MRI) technology and intravenous (IV) contrast dye to visualize blood vessels. Contrast dye causes blood vessels to appear opaque on the MRI image, allowing the doctor to visualize the blood vessels being evaluated.

What is the treatment for renal vascular disease?

Specific treatment will be determined by your doctor based on:

  • Your age, overall health and medical history

  • Extent of the disease

  • Your signs and symptoms

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment will also vary depending on the type of renal vascular disease that is present.

Type of renal vascular disease

Treatment

Renal artery stenosis

Medical treatment:

  • Antihypertensive medications other than ACE inhibitors may be used to treat high blood pressure.

  • In stenosis caused by atherosclerosis, medications to lower cholesterol may be prescribed.

  • Treatment of related medical conditions such as diabetes.

Surgical treatment:

  • Endovascular procedures such as angioplasty (the opening of a renal artery using a balloon or other method) or placement of a stent (a tiny, expandable metal coil placed inside an artery to keep the artery open).

  • Open surgical procedures to bypass the occluded renal artery. There are several variations of such procedures.

Renal artery thrombosis

Treatment of a renal artery thrombosis depends on the type (acute or chronic) of thrombosis, and the length of time since the thrombosis occurred.

In acute situations, thrombolytic (clot-busting) medication may be infused into the renal artery for several hours to several days to break up the clot.

Surgery to remove the clot or bypass the artery may be performed in some situations.

Renal artery aneurysm

Treatment of a renal artery aneurysm depends on factors such as the size and location of the aneurysm and whether or not symptoms are present. Certain types of small (less than two centimeters, or about three-quarters of an inch) aneurysms may not be treated, but may be observed for growth or development of other complications.

Larger aneurysms (greater than two centimeters or three-quarters of an inch), dissecting aneurysms, aneurysms causing kidney ischemia (lack of blood flow to the kidney tissue) and hypertension, aneurysms that are growing larger, and aneurysms causing symptoms may be treated surgically.

Because of the increased risk for rupture (bursting), a renal artery aneurysm in a pregnant woman or a woman of childbearing age will generally be treated surgically.

Atheroembolic renal disease

Treatment of atheroembolic renal disease depends on the extent of the disease and the individual situation.

Medical treatment may include medications to reduce cholesterol, blood pressure, and other related medical conditions, such as diabetes.

Surgical treatment may include:

  • Endovascular procedures such as angioplasty (the opening of a renal artery using a balloon or other method) or placement of a stent (a tiny, expandable metal coil placed inside an artery to keep the artery open).

  • Open surgical procedures to bypass the occluded renal artery. There are several variations of such procedures.

Renal vein thrombosis

Renal vein thrombosis is generally treated medically with anticoagulant (keeps the blood from clotting) medication. Anticoagulants may be given intravenously (IV) for several days, then given orally for several weeks up to an indefinite period of time.

Treatment Programs


Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

Select a treatment program for more information:



Imaging

  • Pediatric Imaging
    The Pediatric Imaging Program at Massachusetts General Hospital Imaging specializes in ensuring the safety and comfort of child patients while providing the latest technology and the expertise of specialized pediatric radiologists.
  • Adult Medicine Imaging
    The Adult Medicine Imaging Program at Massachusetts General Hospital Imaging offers a wide range of diagnostic exams and minimally invasive, image-guided treatments, all provided using leading-edge equipment and interpreted by specialty-trained radiologists.
  • Vascular Imaging and Intervention
    Working as part of the Vascular Center, the interventional vascular specialists of the Vascular Imaging and Intervention Program at Massachusetts General Hospital Imaging perform minimally invasive, image-guided treatments for conditions including stroke and peripheral vascular disease. These same interventionalists also use minimally invasive techniques to treat non-vascular conditions including uterine fibroids and certain kinds of cancer. In addition, our specialty-trained radiologists use the latest imaging technologies to provide diagnostic exams for a full range of vascular conditions.
Transplant Center

  • Kidney/Pancreas/Islet Transplant Programs
    The Kidney/Pancreas/Islet Transplant Programs at Massachusetts General Hospital provide new and unique treatment options for patients with end-stage renal disease (kidney failure) and/or type 1 diabetes.
Vascular Center

  • Visceral Vascular Disease Program
    The Visceral Vascular Disease Program at the Massachusetts General Hospital Vascular Center offers advanced diagnostic techniques and innovative treatments for patients with mesenteric vascular disease and renal vascular disease.
  • Fibromuscular Dysplasia Program
    The Fibromuscular Dysplasia Program at the Massachusetts General Hospital Vascular Center provides patients with specialized care for fibromuscular dysplasia (FMD), a commonly misdiagnosed condition in which the artery is abnormally formed, causing portions to thicken, narrow and even enlarge.
Nephrology Division

  • Center for Renal Education
    The Center for Renal Education provides education about Chronic Kidney Disease and its management and individualized plans of care that include nutritional counseling, blood pressure management, medication review and supportive services.
  • Resistant Hypertension Program
    The Resistant Hypertension Program specializes in the evaluation, diagnosis and management of patients with resistant or difficult to treat hypertension.
  • Chronic Ambulatory Peritoneal Dialysis (CAPD) Program
    The Peritoneal Dialysis Unit provides training and long term management for the patient who selects peritoneal dialysis as home therapy. Staffed by experienced peritoneal dialysis nurses, manual and automated home peritoneal dialysis is available.
  • Renal Associates Clinic
    Renal Associates provides services in general nephrology including diabetes, water and electrolyte disorders, kidney disease in pregnancy, urinary tract infections, and primary and secondary diseases of the kidney.
  • Polycystic Kidney Disease (PKD) Clinic
    The Polycystic Kidney Disease (PKD) Clinic at Massachusetts General Hospital specializes in the diagnosis and management of cystic kidney diseases.

The following related clinical trials and research studies are currently seeking participants at Massachusetts General Hospital. Search for clinical trials and studies in another area of interest.

Patient selection criteria and interventional treatment parameters for renal artery stenosis

The medical community has made great strides treating coronary and carotid artery diseases and reducing mortality associated with myocardial infarctions and strokes. While as many as 3 million Americans have renal artery stenosis (RAS)—a condition that narrows or blocks the vessels that supply blood to the kidneys—RAS is often overlooked and underdiagnosed.

Guy Rordorf, MD, recommends an imaging test for anyone with a family history of FMD

Guy Rordorf, MD, vascular neurologist at the Massachusetts General Hospital Vascular Center, says an imaging test can detect fibromuscular dysplasia (FMD), and recommends it for those with a family history of the condition. Learn more about FMD and how it weakens artery walls and can lead to severe hypertension or stroke.

Innovative care at the Vascular Center

Learn more about the latest treatment options for this condition at the Vascular Center