What is it?
Atherosclerotic renovascular disease (ARVD) is a disease of the arteries in which fatty deposits (plaques) develop on the inside of the main arteries to the kidneys. The process (commonly known as ‘hardening of the arteries’) results in narrowing and hardening of the arteries, so the blood supply to the kidneys becomes increasingly restricted (stenosis).
ARVD can cause chronic kidney disease (CKD) and lead to end-stage kidney disease (ESKD), especially as people get older.
People with ARVD often have circulatory problems and fatty plaque build-up in other arteries elsewhere in the body, including the heart and legs for example. They are also more likely to have other diseases such as diabetes.
Symptoms
The most common symptom is that of high blood pressure (hypertension). Some people with ARVD may have already developed mild to moderate chronic kidney disease, which often has no noticeable symptoms. Others may have some of the symptoms of more advanced kidney disease.
People can also have:
- High blood pressure that does not respond to common drug treatments or needs multiple blood pressure medications to bring it under control
- Sudden attacks of fluid on the lungs, called ‘flash pulmonary oedema’
- ARVD may also be suspected if you experience a drop of more than 20 per cent in your kidney function with certain blood pressure medication.
Risk factors
Your risk of getting ARVD generally increases if you:
- Are older – over 50 years
- Have diabetes
- Smoke
- Have high blood pressure
- Have high blood cholesterol
- Have hardening of the arteries (atherosclerosis) elsewhere in the body
- Have a family history of blood vessel disease.
Diagnosis
A doctor will usually use an ultrasound scan to check the size and condition of your kidneys. If one or both appear to have shrunk to less than normal size this may lead them to suspect that the blood supply is reduced.
An angiogram will then be needed to confirm their diagnosis:
- A CT or MR angiogram involves the injection of a special liquid into a vein to show up your kidney arteries during a CT or MRI scan.
- A renal angiogram can also be done by passing a tube to the renal arteries from an artery in your groin. This can give the best quality pictures, but it is more time-consuming and may be more hazardous than CT or MRI angiograms, so is only used if the diagnosis is uncertain or performed at the same time as a treatment (see ‘procedures’ below).
Treatments
Treatment options may vary, depending on your general health and the severity of your ARVD.
Routine treatments could include:
- Careful management of high blood pressure
- Taking cholesterol lowering drugs
- Taking extra medications for fluid retention or heart failure
- Avoiding some over-the-counter painkillers (e.g. non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and diclofenac) which can reduce the blood supply to the kidneys
You may also be given advice about staying as healthy as possible by:
- eating a healthy diet
- doing regular exercise and
- not smoking
Procedures could include:
- Angioplasty – insertion of a small balloon to open the renal artery. This can be done during an angiogram in which a tube is passed into the renal artery from an artery in the groin.
- A stent (small plastic or sprung mesh metal tube) can be placed through the tube to keep the artery open.
But these treatments can come with some potential drawbacks:
- Angioplasty may not bring back lost kidney function and may not improve blood pressure
- Even when a stent is used, narrowing may come back again
- Both can cause damage to the renal artery which could lead to the loss of that kidney
Some people can significantly improve both kidney function and high blood pressure after these procedures. For example, it is generally accepted that angioplasty with or without stenting is recommended for a patient who has experienced or who is at risk of flash pulmonary oedema or anuric (sudden loss of urine output) acute kidney injury. These procedures should also be considered for people with hard to manage or severe hypertension.
Recent studies have also shown that medication without angioplasty is preferable for most people with clinically stable ARVD.
Your kidney specialist will be able to suggest the best package of treatments and procedures for your individual needs.
Help for you
If you have been diagnosed with ARVD and have any questions or concerns about your illness don’t hesitate to speak to your kidney specialist or your nurse specialist at the kidney unit.
You can also find further information, advice and helpful tips in our Just diagnosed and How can I help myself? sections.
- Renal angiography and angioplasty - from EDREN
- Information leaflets from the British Society for Interventional Radiology
Reviewed April 2019
The need for more research
We need to learn more about how to prevent and treat kidney damage caused by ARVD and other conditions. Some of the research needed also applies to disease of the blood vessels in other parts of the body, for instance coronary disease, stroke, and peripheral vascular disease.
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