Atherosclerotic Renovascular Disease

Atherosclerotic renovascular disease (ARVD), also known as atherosclerotic renal artery stenosis is increasingly recognized to be a cause of chronic renal failure. According to a recent administrative data regarding general population of the elderly greater than 65 years of age in the United States, the prevalence and incidence rates of ARVD were estimated 0.5% and 3.7 per each 1000 person-years respectively (Kalra et al., 2005). In addition, some epidemiological researches demonstrated that the prevalence among those with end-stage renal disease beginning renal replacement therapy was estimated from 5% to 22% (Rimmer & Gennari, 1993; Mailloux et al., 1994; Appel et al., 1995; van Ampting et al., 2003). Of note, ARVD is not only responsible to impaired kidney function but also reflects a status of patients at risk for systemic cardiovascular diseases (Kalra et al., 2005). It has been well known that a variety of risk factors for atherosclerosis share common pathway underlying atherosclerotic renal artery stenosis, coronary artery disease, and peripheral vascular disease. On the contrary, significant high-grade bilateral or isolated renal artery stenosis may cause renovascular hypertension estimating over 50% of ARVD populations by activation of renin-angiotensin-aldosterone system and lipoxygenase pathway that further deteriorate the kidney function (Romero 1997). A previous report uncovered that ARVD was estimated from 1% to 6% in patients with hypertension (Simon et al., 1972). In this regard, a vicious cycle will be established in the progression of renal arterial atherosclerosis, which is characterized by refractory hypertension, acute cardiac events (ie, heart failure, cardiogenic pulmonary edema or acute coronary syndrome), and hence leads to acute or chronic renal failure due to hypertensive or ischemic nephropathy (Buller et al., 2004). Therefore, an early alert of patients at risk for ARVD is critical in slowing down the rate of kidney function loss and providing treatment for underlying cardiovascular disease as well. In this chapter, we will fuel the readers with the classic knowledge in this field and propose the latest evidence-based medicine to manage patients with this disease.