Renal artery stenosis is a relatively uncommon disorder, which presents clinically with hypertension. It has been estimated to occur in about 2% of unselected patients with hypertension but may affect up to 4% of older patients with hypertension who have evidence of atherosclerotic disease elsewhere. Most cases of renal artery stenosis are caused by atherosclerosis but fibromuscular dysplasia involving the vessel wall may be responsible in younger patients. Rare causes include vasculitis, thromboembolism and aneurysms of the renal artery.
Renal artery stenosis can present in various ways including hypertension, renal failure (with bilateral disease), a deterioration in renal function when ACE inhibitors or ARBs are used, or acute pulmonary oedema. Although many patients experience a slight drop in GFR when commencing these drugs, an increase in serum creatinine of 25% or more raises the possibility of renal artery stenosis. Acute pulmonary oedema is particularly characteristic of bilateral renovascular disease. It is associated with severe hypertension, occurring without other obvious cause in patients with normal or only mildly impaired renal function. Clinical evidence of generalised vascular disease may be observed, particularly in the legs, in older patients with atherosclerotic renal artery stenosis. Clinical features associated with an increased risk of renal artery stenosis in hypertensive patients. The presence of one or more of these features should prompt investigation for possible renal artery stenosis, as described below, provided that intervention is being contemplated to improve renal perfusion.
When appropriate, imaging of the renal vasculature with either CT angiography or MR angiography should be performed to confirm the diagnosis. Both give good views of the main renal arteries, the vessels predominantly involved and the most amenable to intervention. Biochemical testing may reveal impaired renal function and an elevated plasma renin activity, sometimes with hypokalaemia due to hyperaldosteronism. Ultrasound may also reveal a discrepancy in size between the two kidneys. While these investigations provide supportive information, they are insufficiently sensitive or specific to be of value in diagnosis of renovascular disease in hypertensive patients.
Well selected Homoeopathic remedies are effective for arteriosclerosis. Along with follow strict diet restrictions.
AURUM METALLICUM - Aurum met is one of the best remedies for arteriosclerosis with valvular lesions. There is a sensation as if heart stopped beating for two or three seconds, immediately followed by tumultuous rebound with sinking at epigastrium. The patient is suffering from high blood pressure. Pulse rapid, feeble and irregular. Pain beneath the breast bone at night Oppression at the heart and having violent palpitations. Mentally the patient is highly depressed, always talk of committing suicide but fear of death. The person is hopeless with grief.
CONIUM MACULATUM - Conium mac is best for arteriosclerosis with violent palpitations. Palpitations worse exertion, drinking, at stools. Pulse unequal and irregular. There is weakness of mind and body with vertigo, trembling and palpitations.
CONVALLARIA MAJALIS - Convallaria majalis is excellent for arteriosclerosis of cigarette smokers. Sensation as if the heart ceased beating, and then starting very suddenly. Another feature is extremely rapid and irregular pulse. Feeling as if heart beat throughout the chest.
CRATAEGUS OXYCANTHA - Crataegus is considered a heart tonic. Crataegus has got great solvent powers upon calcerous and crustaceous deposits in the lumen and arteries. There is least dysponea on least exertion. Extreme shortage of breath with heart pain. The pulse is irregular , feeble and intermittent.
NATRUM IODATUM - Natrum iodatum is for arteriosclerosis with angina pectoris, vertigo and dyspnea.
PLUMBM METALLICUM - Plumbum met is best for arteriosclerosis of anemic, weak persons and those suffering from hypertension. There is painful constriction of peripheral arteries. The pulse soft, small, dicrotic, wiry, slow, sinks even to 40. Plumbum is more indicated when chronic nephritis occurs.
SECALE CORNUTUM - Secale cor is more indicated in the early hardening of arteries, which is rapidly progressive. Secale cor is indicated for arteriosclerosis with ice-cold extremities. There is boring pain in the chest. Dyspnea and oppression occurs with cramps in the diaphragm. Palpitation with intermittent pulse.
STRONTIUM CARBONICUM -Stronium carb is best for arteriosclerosis with high blood pressure producing a flushed face and pulsating arteries. There is violent beating of arteries and heart. Strontium is also good for arteriosclerosis with vertigo and nausea.
STROPHANTHUS HISP. -Strophanthus is best for arteriosclerosis, especially tobacco smokers. The arteries are very rigid and the pulse is rapid, alternating with slow, weak, small and irregular. Cardiac pain and dyspnea.
TABACUM - Tabacum is best for hardening of coronary arteries. There is violent palpitations, worse lying on left side. Pulse thread, intermittent, hard, cord like and imperceptible.