Treatment

Treatment for renal artery stenosis may involve lifestyle changes, medication and a procedure to restore blood flow to the kidneys. Sometimes a combination of treatments is the best approach. Depending on your overall health and symptoms, you may not need any specific treatment.

Lifestyle changes

If your blood pressure is moderately or severely elevated, a healthy lifestyle — limiting salt, eating healthy foods and getting regular physical activity — can help control your blood pressure.

Medication

High blood pressure — even when mainly related to renal artery stenosis — often can be successfully treated with medications. Finding the right medication or combination of medications may require time and patience.

Some medications commonly used to treat high blood pressure associated with renal artery stenosis include:

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), which help relax your blood vessels and block the formation or effects of a natural body chemical called angiotensin II, which narrows blood vessels
• Diuretics, also known as water pills, which help your body eliminate excess sodium and water
• Beta blockers and alpha-beta blockers, which may have the effect of making your heart beat slowly and less forcefully or widening (dilating) your blood vessels, depending on which medication you use
• Calcium channel blockers, which help relax blood vessels

If atherosclerosis is the underlying cause of renal artery stenosis, your doctor may also recommend aspirin and a cholesterol-lowering medication. Which medications are best for you depends on your individual situation.

Procedures

For certain people a procedure may be recommended to restore blood flow through the renal artery to improve blood flow to the kidney.

Results from clinical trials comparing medication with renal angioplasty and stenting didn't show a difference between the two treatment approaches on reducing high blood pressure and improving kidney function for patients with moderate renal artery stenosis. Procedures to open the vessel should be considered for people who don't do well on medicine alone, who can't tolerate medications, who often retain fluids and who have treatment-resistant heart failure.

Procedures to treat renal artery stenosis may include:

• Renal angioplasty and stenting. In this procedure, doctors widen the narrowed renal artery and place a device (stent) inside your blood vessel that holds the walls of the vessel open and allows for better blood flow.
• Renal artery bypass surgery. During a bypass procedure, doctors graft a substitute blood vessel to the renal artery to make a new route for blood to reach your kidneys. Sometimes this means connecting the renal artery to a vessel from somewhere else, such as the liver or spleen. These operations are most often done if angioplasty isn't successful, or when there's a need for additional surgical procedures.