Renal artery stenosis

Know the causes of arterial stenosis in men and in women and the site of stenosis in arteriosclerosis and fibromuscular dysplasia

• Atheromatous plaques – occurs more frequently in males, incidence increases with age and presence of DM

• Fibromuscular dysplasia – more common in females in 30s-40s

• Thickening most commonly affects media, but can also involve intima and adventitia

• Produces a single / series of narrowing(s), usually in the middle / distal portion of the renal artery (not usually at ostium). May also involve segmental branches.

Know the pathology of fibromuscular dysplasia and morphologic change in the kidney of renal artery stenosis

• Effects of increased HTN (i.e., hyaline change) are more severe in kidney w/o stenotic artery

• Kidney shows signs of ischemia:

• Atrophy of tubules

• Sclerotic glomeruli

• Interstitial inflammation

• Focal inflammation

• Hyperplasia of JGA – Increased granularity

Know the prognosis of renal artery stenosis in atherosclerosis and in fibromuscular dysplasia (FMD)

• Prognosis after surgery is 90% in FMD, and 60-75% in atherosclerotic stenosis

• This difference may be due to the fact that FMD becomes symptomatic at an earlier age

Category: Pathology Notes