• Renal (Kidney) Artery Disease Treatment

     
     
    9/16/2011

    Without treatment, renal (kidney) artery disease (RAS) may cause high blood pressure and eventually lead to kidney failure. If your kidneys fail, they can no longer filter the blood and rid the body of waste products. And, to survive you will need a kidney transplant or regular medical visits for kidney dialysis—so a machine can filter your blood for you. 

    But treatment options are available to help prevent or slow the development of RAS. Your physician will consider the full spectrum of options in deciding what is best for you. The earlier RAS is diagnosed and the sooner treatment begins, the better your prospects for slowing its progress and avoiding high blood pressure and kidney failure. 

    Spectrum of Care

    The type of treatment you receive for RAS, as with cardiovascular disease in general, depends on your personal circumstances, the extent of disability and risk, and the nature of the problem. 

    If you have blockages in your arteries, your physician will assess the severity of your cardiovascular disease and where you best fit among a range of treatment options – sometimes referred to as the spectrum of care. The spectrum of care options for cardiovascular disease consist of a combination of treatments including

    • Lifestyle changes  
    • Medications   
    • Revascularization, or treatment to re-establish blood flow through a narrowed artery. Options for revascularization include:   
      • Angioplasty and stenting and other interventional procedures 
      • Bypass surgery  

    Some patients may be at the beginning stages of cardiovascular disease. In this case, changing lifestyle elements such as diet and exercise might be enough to get you back on track for good health. For other patients, medication in addition to lifestyle changes can slow or reverse the progress of cardiovascular disease. For patients with more advanced disease, revascularization, in addition to medication and lifestyle changes may be necessary. 

    If you have an interventional cardiologist on your care team, he or she will work in conjunction with other healthcare providers to determine which treatment options are likely to benefit you most. These treatment decisions are based on education and experience, as well as being grounded in practice guidelines – standards developed by leading experts in the field of cardiology to guide the profession. These frequently updated guidelines are drafted after careful review of all the peer-reviewed information and data available. Interventional cardiologists use the 2009 Focused Updates: STEMI and PCI Guidelines jointly developed by the American College of Cardiology, American Heart Association, and the Society for Cardiovascular Angiography and Interventions, as well as guidelines developed by the European Society of Cardiology

    Throughout the decision-making process, the patient is also a core member of the care team. You can help your interventional cardiologist determine which treatment options make the most sense for you based on desired quality of life. Participating in your own care starts with something as simple as writing down questions you may have about the procedure and bringing that list to your next appointment. Your interventional cardiologist can work with you to find a truly individualized treatment. 

    Lifestyle Changes

    Most physicians will recommend lifestyle changes and medications as the first line of treatment for RAS. If RAS becomes worse, more aggressive procedures, including angioplasty and stenting and surgery, may be recommended. 

    Medical Therapy
    Your doctor may prescribe medications to manage the following risk factors for RAS and to slow the progression of the disease:

    • Blood Pressure
      High blood pressure can be caused by blockages in the arteries to the kidneys and it can also be a risk factor for developing RAS, as well as heart attack, stroke, kidney disease, and eye problems. By taking steps to lower and control your blood pressure, you can prevent or delay the development of RAS and a range of other health problems.
    • Cholesterol
      If you have RAS, you can reduce your risk of heart attack or stroke by controlling your cholesterol level.  Be sure to ask your doctor what the medicines are for and how and when you should take them. And don’t hesitate to let your doctor know if you have side effects. There may be other medications that work better for you.
    • Diabetes
      The increasing rate of obesity is contributing to a higher rate of diabetes. And with the increase in diabetes, it is becoming the most common – and a serious – risk factor for RAS. If you have diabetes, your risk of also developing RAS is higher than for people who do not have diabetes. And if you have RAS and diabetes your risk for high blood pressure and kidney failure, as well as heart attack or stroke is much higher than for people who have RAS only. Your risk of dying at a younger age may also be higher. 
      Medical guidelines recommend that people over age 50 with diabetes be tested for RAS. They also recommend testing for people under age 50 with diabetes who also have risk factors for RAS, including smokinghigh blood pressure and high cholesterol.
    • Atherosclerosis

    RAS is the result of atherosclerosis, or a build up of plaque, which can cause               blockages in the arteries. If you have blockages in the arteries that lead to the             kidneys, you may also have blockages in arteries that supply blood to other organs that can lead to heart attack or stroke. Antiplatelet drugs, such as aspirin, may prevent blood clots that limit or block the blood flow in these arteries. Antiplatelet drugs act to thin the blood, making it less likely that blood cells will clump together to form clots. Your healthcare provider will work with you to determine the medications that are best for you.

    Endovascular and Surgical Procedures
    If you need more aggressive treatment than lifestyle changes and medications, your doctor may recommend endovascular or surgical procedures to treat blockages in your renal arteries. Both treatments can restore blood flow to the kidneys. When blood flow is restored, kidney function improves and the high blood pressure caused by a blocked renal artery may be lowered. After treatment of a renal artery, you may still have high blood pressure, but you may need less medication to control it. 
    Endovascular Procedures
    An endovascular procedure is one that is performed inside the blood vessels through the use of a small, flexible tube, called a catheter. An endovascular procedure is performed by a doctor with special endovascular training. RAS can be treated by a number of specialists, including interventional cardiologists, vascular surgeons, interventional radiologists, and vascular medicine specialists.

    There are a number of endovascular procedures that may be recommended for the treatment of RAS, but the two most common are balloon angioplasty and stenting.  These procedures have been used for decades to treat blocked arteries to the heart to restore blood flow and prevent or stop chest pain, heart attack, and stroke. If you have questions about stents, click here to learn more.

    Angioplasty and Stenting

    Your interventional cardiologist or other vascular specialist may recommend angioplasty and stenting to open the blocked arteries and restore blood flow to your legs. Angioplasty is a procedure performed in the catheterization laboratory, or “cath lab,” in a hospital. You will lie on a table and be mildly sedated to help you relax, but you will remain awake throughout the procedure. 

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    Stent Placement

    A thin flexible tube called a catheter is inserted into the artery and threaded through the arteries to the blockage. (Since there are no nerves in your arteries, you will not feel the catheter.) An x-ray camera and images of your arteries on a television screen help the physician guide the catheter to the blockage. A tiny, thin wire is then passed across the narrowed segment of the artery. It serves as a support for positioning the tiny balloon across the blockage. 

    Next, a balloon catheter – a long, thin flexible tube with a small uninflated balloon at its tip – is threaded into the artery to where the artery is narrowed. Once in position, the balloon is inflated to open the artery and most cases place a metal mesh tube called a stent to hold the artery open and reduce the risk of the artery narrowing again. After the placement of the stent your doctor will remove all catheters.

    After Your Procedure

    Most patients with RAS who are treated with angioplasty and stenting are released from the hospital 12 to 24 hours after the catheter is removed. Many patients are able to return to work within a few days to a week after a procedure. If your interventional procedure included insertion of a stent, your interventional cardiologist or other vascular specialist will provide prescriptions for blood-thinning drugs, such as aspirin and clopidogrel, typically for a month to a year. It is very important that you follow your doctor’s instructions for these medications. And even after you begin to feel better, you should never stop taking your medications at any time without speaking with your interventional cardiologist.

    What to Expect at Home 

    After an interventional procedure, it is normal to: 

    Have a bruise or discolored area near where the catheter was inserted. At the same site, there may also be a small lump (which should not get bigger), soreness when pressure is applied and perhaps a small amount (one or two drops) of discharge.  

    When to call the doctor:

    • If the puncture wound gets bigger, turns red, drains a thick yellow/brown material, or is painful, even when no pressure is applied. A larger, painful lump may be a sign that the puncture hole is not healing properly or is leaking blood. 
    • If you have fever. 
    • If you experience swelling – with or without pain – anywhere in the leg in which the catheter was inserted.  

    Resuming Normal Activities After Your Procedure 

    Always follow your doctor’s instructions about the activity level appropriate for you. Once you leave the hospital, your post-procedure care will be two-fold. You will need to take care of yourself by taking medication exactly as prescribed, as well as making lifestyle changes such as exercising, improving your diet, and quitting smoking if you smoke. You should also have at least one follow-up appointment with your treating interventional cardiologist or another qualified specialist if you are not able to return to your treating physician. At this appointment, your interventional cardiologist will examine the catheter insertion site to be sure it is healing properly.

    If you would like to know more about angioplasty and stenting, see Questions to Ask Your Interventional Cardiologist about Stents.

    Restenosis

    Arteries can become blocked again after they have been treated. A re-narrowing of the artery, called restenosis may cause you to again experience high blood pressure or other complications due to RAS. A second procedure may be needed to widen the artery again.

    To keep your vessels from clogging again and to protect your health, it is extremely important to take the medications prescribed by your doctor and to exercise regularly, eat a healthy diet, manage your diabetes and avoid smoking. 

    Surgery
    Surgeons use one of two surgical procedures to treat RAS:

    • Endarterectomy, in which the surgeon removes the inner lining of the renal artery (as well as the plaque that causing the blockage) or
    • Bypass surgery in which the surgeon creates a detour or bypass around the portion of the artery that is blocked or narrowed to provide a channel for blood to continue to flow to the kidneys. A vein taken from another part of your body, or a tube made of man-made materials, is attached above and below the blockage to create the detour. Bypass surgery to treat RAS is a complicated procedure that is rarely used.

    Treatment—Not a Cure

    Remember, medication and procedures, such as angioplasty, stenting and surgery, do not cure RAS because we continue to accumulate plaque in our arteries throughout our lives. Arteries can become blocked again after they have been treated. A re-narrowing of the artery, called restenosis, may cause you to experience leg or foot pain again. If you feel pain after you have been treated, call your doctor. A second procedure may be needed to widen the artery again.