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Kidney non-tumor

Blood vessel disorders

Renal artery stenosis

Reviewers: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 26 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.


● Hypertension that responds to ACE inhibitors, with stenosis by intravenous pyelogram or renal scans, bruit, elevated renin
● 2-5% of cases of hypertension, surgery curative in 70%


Atheromatous plaque: more common in older men with diabetes, often at orifice of renal artery and associated with aneurysmal dilatation of aorta distal to renal arteries
Fibromuscular dysplasia: more common in younger women; may involve other vessels; not responsive to hypertensive drugs; 50% bilateral, often involve distal 2/3 of renal artery; due to intimal, medial, perimedial or periarterial fibroplasia, medial hyperplasia or medial dissection
Radiation injury: loss of muscle, intense fibrosis in all wall layers; usually after radiation treatment, including renal artery field years previous
Takayasu’s aortitis: also called pulseless disease; chronic sclerosing aortitis of unknown etiology

Case reports

● 4 year old boy with segmental renal artery stenosis (Am J Surg Pathol 1994;18:512)
● 35 year old woman with aortic coarctation and renal artery stenosis due to fibromuscular dysplasia (Arch Pathol Lab Med 1989;113:809)
● Due to misplaced surgical clips post-nephrectomy (BMJ Case Rep 2012 Aug 13)


● Anti-hypertensive medications
● Angioplasty with stent placement may be effective, even in transplanted kidney (Nefrologia 2012;32:455)
● Revascularization is usually not effective for atherosclerotic renovascular disease (Nephrol Dial Transplant 2012;27:3843, Cardiol Rev 2012;20:189)

Gross description

● Shrunken kidney

Gross images

Renal artery stenosis with atrophic kidney

Micro description

● Diffuse atrophy with crowded and smaller glomeruli, atrophic tubules and interstitial fibrosis (Lab Invest 1991;65:558)
● Arterioles usually normal
● Usually no hypertensive changes in small vessels, although opposite kidney may show hypertensive changes
Medial fibroplasia: multiple foci of stenosis alternate with microaneurysms to produce “string of beads”
Perimedial fibroplasia: normal outer half of media but hyperplasia of muscle causes uniform circumferential thickening of vessel wall with luminal narrowing
Intimal fibroplasia: hyperplasia of intima, resembling atherosclerosis, but without lipid deposition
Periarterial fibroplasia: rare, fibrosis of adventitia extends into adjacent adipose and connective tissue, causing constriction from without

Micro images

Patient with central renal artery stenosis and persistent allograft dysfunction shows focal acute tubular injury and intratubular proteinaceous cast material (asterisk)

End of Kidney non-tumor > Blood vessel disorders > Renal artery stenosis

Ref Updated: 8/24/12

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