Severe bilateral narrowings (or a severe narrowing with a single kidney) may also cause "flash" pulmonary oedema (fluid in the lungs) usually in association with severe hypertension.
In younger patients (under the age of 50) renal artery stenosis may be due to a problem with the muscle in the wall of the renal artery ("fibromuscular dysplasia"). In older patients, it is more often due to atheromatous plaque in the wall of the aorta that affects the origins of the renal arteries.
Treatment of renal artery stenosis through a catheter is safe and effective, and an open surgical procedure is almost never necessary. Balloon angioplasty usually works well for the treatment of hypertension due to fibromuscular dysplasia (usually stent deployment is not necessary). Stenting of atheromatous narrowings at the origins of the renal arteries in older patients is helpful where there is a single kidney, or severe bilateral disease associated with deteriorating renal function, flash pulmonary oedema and intractable hypertension. (It is unlikely to "cure" the hypertension, but it may reduce the number of agents needed to control it). Unfortunately, the combination of moderate hypertension and widespread atheroma (including disease of the renal artery origins) is very common, and not all patients will benefit from renal artery stenting.
There are no good randomised trials of optimal medical management versus stenting in this condition.
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