Renovascular Disease


Renovascular disease is a term for diseases of the renal vessels (small, medium or large) but not including vasculitis. The majority affect the large vessels, with atherosclerotic renal artery stenosis (ARAS) being the most common type, and fibromuscular dysplasia second most common. Vascular disease of the small renal vessels is called ischaemic nephropathy.


There are a number of clinical scenarios in which renovascular disease should be considered as a possible diagnosis:

  • Patients with coronary or peripheral vascular disease
  • Patients with hypertension failing to respond to therapy with three anti-hypertensives
  • All patients with renal dysfunction
  • If a significant drop in eGFR occurs on starting treatment with ACEi/ARB
  • Diuretic resistant fluid retention
  • Acutely - patient with flash pulmonary oedema (sudden pulmonary oedema and hypertension with no precipitating cardiac event - RAAS dysfunction)
  • Acutely - renal infarction with loin pain, sudden renal function decline and new-onset haematuria


  • Swollen legs
  • Past history or MI, ischaemic stroke or intermittent claudication suggesting systemic atherosclerosis
  • General symptoms of poor renal function: fatigue, malaise, itch


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