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Medical Management of Renovascular Disease

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Renal Vascular Disease

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Abstract

All patients with renovascular disease will require antihypertensive drug therapy during some stage of their disease. At least in the case of atherosclerotic renovascular disease, most patients will remain hypertensive to some degree despite a technically successful intervention such as balloon angioplasty and stenting or surgical revascularization. Additionally, given the equivocal results of recent intervention trials, medical management alone is becoming increasingly popular. These trials have also demonstrated the increasing effectiveness of currently available antihypertensive drug regimens. Most regimens are based upon the use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers. Progressive worsening in renal function or clinically significant hyperkalemia during medical management with these drugs has not been common during these recent prospective trials though most participants had only mild degrees of renal impairment at enrollment. The use of calcium channel blockers, diuretics, and vasodilators also form an important part of medical management of hypertension whereas attention to other risk factors for progressive atherosclerotic disease such as dyslipidemia, hyperglycemia, and tobacco use should not be overlooked. Finally, laparoscopic nephrectomy remains an option in the patient with poorly controlled hypertension and a severely ischemic kidney that is not amenable to revascularization.

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  1. Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA

    Vincent J. Canzanello MD

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  1. Vincent J. Canzanello MD
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Correspondence to Vincent J. Canzanello MD .

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  1. Div of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA

    Lilach O. Lerman

  2. Div of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA

    Stephen C. Textor

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Canzanello, V.J. (2014). Medical Management of Renovascular Disease. In: Lerman, L., Textor, S. (eds) Renal Vascular Disease. Springer, London. https://doi.org/10.1007/978-1-4471-2810-6_19

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  • DOI: https://doi.org/10.1007/978-1-4471-2810-6_19

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