Shall we talk about renal artery stenosis?

Do you have high blood pressure (hypertension)? Do you feel like you have difficulty controlling it even after taking several medications? Or has the doctor told you that your kidneys are not functioning properly for no apparent reason? Sometimes the cause of these problems is a condition that we don't talk about much, but is very important. Today we are going to talk about it. That is the narrowing of the blood vessels that lead to the kidneys, in medicine we call this Renal Artery Stenosis.

Simply put, what is Renal Artery Stenosis?

Okay, let's understand this this way. The two kidneys in our body are like two filters. The main function of the kidneys is to filter the waste products in the body from the blood and excrete them as urine. To do this job properly, the kidneys need to receive a good blood supply. There are two main blood vessels that carry blood from our heart to the kidneys. We call these 'Renal Arteries'.

Renal Artery Stenosis is a condition where one or both of the arteries that carry blood to the kidneys become narrowed from the inside. It's like a water pipe getting clogged with dirt. When the arteries become blocked like this, the kidneys don't get the blood they need. This can cause two main problems:

1. High Blood Pressure: When blood flow to the kidneys decreases, the kidneys think that the blood pressure in the entire body has decreased. So they release hormones to try to increase the blood pressure in the body. This results in high blood pressure that is difficult to control.

2. Kidney damage: When the blood does not provide the necessary nutrients and oxygen for a long time, the cells in the kidneys begin to be damaged. If this continues, it can progress to chronic kidney disease and eventually lead to kidney failure.

Who is most at risk of developing this condition?

The main reason for this is a condition called Atherosclerosis . Think of the water pipe in our kitchen sink. Over time, things like oil and dirt get stuck in it and get stuck in the pipe, right? The same thing happens inside our blood vessels. Unwanted things like oil and cholesterol in the food we eat get stuck on the walls of the blood vessels like a crust. We call this 'plaque'. Over time, this plaque accumulates and reduces the space inside the veins. When this happens in the veins that carry blood to the kidneys, Renal Artery Stenosis occurs.

So, anything that contributes to atherosclerosis also increases the risk of renal artery stenosis. Let's see what those are.

In addition to atherosclerosis, this disease can also be caused by a rare condition called Fibromuscular Dysplasia . This is when cells in the walls of blood vessels grow abnormally, narrowing the vessels. This condition is more common in women.

What are the symptoms? How do you know if you have it?

Here's the big problem. Renal Artery Stenosis doesn't cause any symptoms until it's very severe. It's only when the blood vessels become too narrow that problems start to arise. The problems we talked about earlier are high blood pressure and kidney failure.

As your kidneys function decreases, you may experience symptoms such as:

• Swelling in parts of the body: especially the legs, ankles, and sometimes the face (edema).
• Fatigue and drowsiness: You may feel tired all the time due to the accumulation of waste products in the body.
• Difficulty breathing: This condition can be caused by fluid accumulating in the lungs.
• Loss of appetite, nausea, and vomiting.
• Difficulty concentrating, desperation.
• Frequent or infrequent urination.
• Skin changes: Dry skin, itching, or darkening of the skin.
• Being thin for no reason.
• Frequent headaches.
• Muscle cramps.

How does a doctor diagnose this condition?

When you go to see your doctor, he or she may suspect this based on your symptoms and risk factors. Then, they may run a few tests to confirm the condition.

1. Physical examination: The doctor will measure your blood pressure. The stethoscope will be placed in your abdomen, just above your kidneys, and they will listen for a distinctive 'whoosh' sound, which is the sound of blood rushing through a narrowed artery.

2. Kidney Function Tests: Blood and urine samples are tested for this. They look for elevated levels of waste products like creatinine and urea in the blood, and for protein in the urine. These can give an idea of ​​whether the kidneys have been damaged.

3. Imaging Scans: This is the best way to accurately determine if the veins are blocked.

• Duplex Ultrasound: This uses sound waves to take images of the veins that carry blood to the kidneys, checking how the blood is flowing and whether the veins are blocked.
• CT angiography (CTA): A CT scan is performed by injecting a special contrast dye into the body. This produces 3D images of the blood vessels and can clearly see areas of blockage.
• MR Angiography (MRA): This is similar to CTA, but it uses a magnetic field.

What are the treatments for this?

Treatment depends on how blocked your blood vessels are, the nature of your symptoms, and how much damage has been done to your kidneys. There are three main types of treatment.

1. Lifestyle changes

This is the foundation, because it is essential to control the underlying cause, atherosclerosis.

• Healthy diet: Focus on foods low in salt, sugar, oil, and cholesterol. Include more fruits, vegetables, legumes, and whole grains in your diet.
• Regular exercise: It is very important to engage in simple exercise, such as walking for at least 30 minutes a day.
• Weight control: If you are overweight, losing weight can help control blood pressure, cholesterol, and diabetes.
• Completely abstaining from smoking: This is something that you definitely need to do.

2. Medicines (types of medicines)

Along with lifestyle changes, your doctor may prescribe several medications for you.

• Blood pressure medications: ACE inhibitors and ARBs are the most commonly used medications. These block hormones that narrow blood vessels. Other medications, such as beta-blockers and calcium channel blockers, may also be used.
• Cholesterol-lowering drugs: A class of drugs called statins reduces the level of harmful cholesterol in the blood and controls plaque buildup.
• Anticoagulants: Medications like aspirin thin the blood and make it easier for blood to flow through narrowed veins.
• Diuretics: These help lower blood pressure by eliminating excess water and salt from the body through urine.

3. Surgery or other procedures

If the vein blockage is severe enough that it cannot be controlled with medication and lifestyle changes, or if kidney function is rapidly declining, your doctor may recommend surgery.

• Angioplasty and Stenting: This is the most common treatment. In this procedure, a very thin tube (catheter) is passed through a vein in the leg or arm to the blocked renal vein. A small balloon at the end of the tube is inflated to widen the blocked area. Then, a small mesh-like tube (stent) is placed in the vein to keep it from closing again.
• Renal Artery Bypass: Similar to a heart bypass, this procedure involves creating a new path for blood to bypass the blocked artery. This involves using a piece of blood vessel taken from another part of the body or an artificial tube.
• Renal Endarterectomy: This is a surgical procedure that opens up the blood vessel and removes the plaque that has built up inside.

When should you see a doctor immediately?

If you know you have Renal Artery Stenosis, or if you have kidney disease, and experience any of the following symptoms , see a doctor immediately or go to the Emergency Department (ETU) of the nearest hospital.

This condition can get progressively worse over time. Therefore, it is very important to recognize it early and follow your doctor's instructions carefully. If you do so, you can minimize the damage to your kidneys and live a normal life.

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