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Can low-grade renal artery stenosis be considered as cause for renovascular hypertension?

Journal of Human Hypertension volume 36, pages 420–422 (2022)Cite this article

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The current paradigm regarding atherosclerotic renal artery stenosis (ARAS) holds that hemodynamic changes in the kidney do not occur until the degree of stenosis, as determined radiologically, is at least 70% [1]. In most stent trials, therefore, patients have been included only when the luminal narrowing of the stenosis exceeded 70%. However, the strict focus on the anatomic severity of a stenosis is increasingly being abandoned in favor of functional measurements such as pressure gradients and renal fractional flow reserve [2, 3]. Even so, patients are considered for revascularization only when they have severe renal artery stenosis, although there are no compelling data, at least not in humans, to support this approach [4,5,6,7].

As ARAS forms part of a generalized atherosclerotic process, it is conceivable that other factors than renal hypoperfusion per se are involved in causing renal damage [8]. For instance, even with lesser degrees of stenosis local alterations in shear stress and distensibility of the vascular wall may modify endothelial function. Indeed, both experimental and clinical evidence suggests that already in the early stages of ARAS, histological damage occurs and that renal function may be compromised, regardless of stenosis severity [9,10,11,12].

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Authors and Affiliations

  1. Department of Medicine, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands

    Arend J. J. Woittiez & Michaël C. de Vogel

  2. Department of Medicine, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands

    Michaël C. de Vogel

  3. Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands

    Peter W. de Leeuw

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  1. Arend J. J. Woittiez
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  3. Peter W. de Leeuw
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AJJW was responsible for setup of the studies, for writing the paper, for the statistical analysis, for editing the paper as corresponding author. McdV did the data-collection and analysis, was co-writer of the paper, and draw the figure. PWdL was also responsible for the setup and structure of the paper. He assisted with statistical analysis, writing the paper, and editing the writing process.

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Correspondence to Arend J. J. Woittiez.

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Woittiez, A.J.J., de Vogel, M.C. & de Leeuw, P.W. Can low-grade renal artery stenosis be considered as cause for renovascular hypertension?. J Hum Hypertens 36, 420–422 (2022). https://doi.org/10.1038/s41371-021-00628-y

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