For patients diagnosed with renal artery stenosis, pharmacological management primarily focuses on controlling blood pressure, reducing cardiovascular risk, and preventing thrombotic events, especially when the stenosis is due to atherosclerosis NICE CKS,NICE CG147.
Blood pressure management is crucial, with a target blood pressure typically below 140/90 mmHg, or below 135/85 mmHg if the patient is also managing their blood pressure at home NICE NG136. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are often considered first-line agents for hypertension; however, they should be used with caution in patients with renal artery stenosis, particularly in cases of bilateral renal artery stenosis or stenosis in a solitary kidney, due to the risk of acute kidney injury NICE NG203. Regular monitoring of kidney function and serum potassium levels is essential when these drugs are initiated or titrated in such patients NICE NG203. Other antihypertensive agents may be used if ACE inhibitors or ARBs are contraindicated or not tolerated NICE NG136.
Antiplatelet therapy, such as aspirin, is recommended for patients with atherosclerotic renal artery stenosis to reduce the risk of cardiovascular events NICE CKS,NICE CG147. This aligns with general management strategies for atherosclerotic disease Meier 2011.
Lipid-lowering therapy with statins is also recommended for patients with atherosclerotic renal artery stenosis to reduce cardiovascular morbidity and mortality NICE CKS,NICE CG147. These pharmacological strategies are integral to the overall management of atherosclerotic renal artery stenosis Meier 2011.
Key References
- CKS - Peripheral arterial disease
- CKS - Hypertension
- NG203 - Chronic kidney disease: assessment and management
- NG136 - Hypertension in adults: diagnosis and management
- CG147 - Peripheral arterial disease: diagnosis and management
- (Meier, 2011): Atherosclerotic renal artery stenosis: update on management strategies.