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the physical condition of blocking or filling a passage with an obstruction (同)blockage
any structure that makes progress difficult (同)obstructor, obstructer, impediment, impedimenta
getting in someones way
the act of obstructing; "obstruction of justice"
a major thoroughfare that bears important traffic
a blood vessel that carries blood from the heart to the body (同)arteria, arterial blood vessel

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〈U〉(…への)妨害,障害《+『to』+『名』》 / 〈C〉(…への)妨害物,障害物《+『to』+『名』》
動脈 / (道路・水路・鉄道などの)勘線,(通信の)主チャンネル
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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/26 22:09:17」(JST)

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Renal artery stenosis is the narrowing of the renal artery, most often caused by atherosclerosis or fibromuscular dysplasia. This narrowing of the renal artery can impede blood flow to the target kidney, resulting in high blood pressure. Atrophy of the kidney with decreased blood flow may occur, which can lead to unilateral chronic kidney disease, including kidney failure.

Signs and symptoms

Most cases of renal artery stenosis are asymptomatic, and the main problem is high blood pressure that cannot be controlled with medication. Decreased kidney function may develop if both kidneys do not receive adequate blood flow, or when treatment with an ACE inhibitor is started. Some people with renal artery stenosis present with episodes of flash pulmonary edema (sudden left ventricular heart failure).^[1]

Diagnosis

The gold standard investigation to diagnose renal artery stenosis is digital subtraction angiography.^[2]

Doppler ultrasound study of the kidneys
refractory hypertension - high blood pressure that cannot be controlled adequately with antihypertensives
auscultation (with stethoscope) - bruit ("rushing" sound) on affected side, inferior of the costal margin
captopril challenge test
captopril test dose effect on the differential renal function as measured by MAG3 scan.^[3]
renal artery arteriogram

A clinical prediction rule is available to guide diagnosis.^[4]

Cause

Atherosclerosis is the predominant cause of renal artery stenosis in the majority of patients, usually those with a sudden onset of hypertension at age 50 or older. Fibromuscular dysplasia is the predominant cause in young patients, usually females under 40 years of age. A variety of other causes exist. These include arteritis, renal artery aneurysm, extrinsic compression (e.g., tumors), neurofibromatosis, and fibrous bands.

Pathophysiology

The granular cells of the afferent arteriole senses a decreased systemic blood pressure owing to the reduced blood flow through the narrowed artery. The response of the kidney to this perceived decreased blood pressure is activation of the renin-angiotensin aldosterone system, which normally counteracts low blood pressure but in this case leads to hypertension (high arterial blood pressure). The decreased perfusion pressure (caused by the stenosis) leads to decreased blood flow (hypoperfusion) to the kidney and a decrease in the GFR. If the stenosis is longstanding and severe the GFR in the affected kidneys never increases again and (prerenal) kidney failure is the result.

Treatment

Atherosclerotic renal artery stenosis

It is initially treated with medications. These include statins, antiplatelet agents, and medications for blood pressure control. When high-grade renal artery stenosis is documented and blood pressure cannot be controlled with medication, or if renal function deteriorates, invasive procedure may be resorted to.

The most commonly used invasive procedure is angioplasty with or without stenting. It is unclear if this approach yields better results than the use of medications alone.^[5] It is a relatively safe procedure.^[5]

If all else fails and the kidney is thought to be worsening hypertension and revascularization with angioplasty or surgery does not work, then surgical removal of the affected kidney (nephrectomy) may significantly improve high blood pressure.

Fibromuscular dysplasia

Angioplasty with or without stenting is the best option for the treatment of renal artery stenosis due to fibromuscular dysplasia.

References

^ Pickering TG; Herman L; Devereux RB et al. (1988). "Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation". Lancet 2 (8610): 551–2. doi:10.1016/S0140-6736(88)92668-2. PMID 2900930.
^ Sam, Amir H.; James T.H. Teo (2010). Rapid Medicine. Wiley-Blackwell. ISBN 1405183233.
^ Roccatello D, Picciotto G (1997). "Captopril-enhanced scintigraphy using the method of the expected renogram: improved detection of patients with renin-dependent hypertension due to functionally significant renal artery stenosis" (PDF). Nephrol. Dial. Transplant. 12 (10): 2081–6. doi:10.1093/ndt/12.10.2081. PMID 9351069.
^ Krijnen P, van Jaarsveld BC, Steyerberg EW, Man in 't Veld AJ, Schalekamp MA, Habbema JD (1998). "A clinical prediction rule for renal artery stenosis". Ann. Intern. Med. 129 (9): 705–11. doi:10.7326/0003-4819-129-9-199811010-00005. PMID 9841602.
^ ^a ^b Jenks, S; Yeoh, SE; Conway, BR (5 December 2014). "Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis.". The Cochrane database of systematic reviews 12: CD002944. doi:10.1002/14651858.CD002944.pub2. PMID 25478936.

UpToDate Contents

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1. 片側性アテローム性腎動脈狭窄症の治療 treatment of unilateral atherosclerotic renal artery stenosis
2. アテローム性腎動脈狭窄に起因する慢性腎疾患の臨床症状および診断 clinical manifestations and diagnosis of chronic kidney disease resulting from atherosclerotic renal artery stenosis
3. 両側性アテローム性腎動脈狭窄症および機能的単腎の狭窄の治療 treatment of bilateral atherosclerotic renal artery stenosis or stenosis to a solitary functioning kidney
4. 尿路閉塞および水腎症の臨床症状および診断 clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis
5. 腎臓の同種移植片機能不全の鑑別診断 differential diagnosis of renal allograft dysfunction

English Journal

Atherosclerotic Renal Artery Stenosis: Current Status.

Kwon SH1, Lerman LO2.
Advances in chronic kidney disease.Adv Chronic Kidney Dis.2015 May;22(3):224-231. doi: 10.1053/j.ackd.2014.10.004.
Atherosclerotic renal artery stenosis (ARAS) remains a major cause of secondary hypertension and kidney failure. Randomized prospective trials show that medical treatment should constitute the main therapeutic approach in ARAS. Regardless of intensive treatment and adequate blood pressure control, h
PMID 25908472

Current approaches to atherosclerotic obstructive renal artery stenosis.

Juncos LI1, Textor S2.
Therapeutic advances in cardiovascular disease.Ther Adv Cardiovasc Dis.2015 Apr 22. pii: 1753944715579143. [Epub ahead of print]
Increased lifespan in the last few decades has substantially changed the scenario for renal artery stenosis. Indeed, because older populations show a higher prevalence of atherosclerotic disease, the incidence of atheromatous renal artery stenosis has also increased. Intuitively, one could surmise t
PMID 25907506

Japanese Journal

腎臓移植における超音波検査の役割

西日本泌尿器科 = The Nishinihon journal of urology 77(8), 283-288, 2015-08
NAID 40020561650

腹部大動脈瘤による十二指腸狭窄の1例

日本臨床外科学会雑誌 76(3), 484-487, 2015
NAID 130005101754

胸部大動脈瘤ステントグラフト内挿術後にステントグラフト狭窄を来し，バルーン拡張により末梢塞栓症を生じた1 例

日本血管外科学会雑誌 24(2), 77-81, 2015
NAID 130005066028

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★リンクテーブル★

リンク元	「腎動脈閉塞症」「腎動脈閉塞」「renal artery occlusion」「renal artery stenosis」
関連記事	「obstruction」「renal」