Ischaemic nephropathy

Ischaemic nephropathy can be difficult to define, but it most frequently refers to progressive kidney function loss due to atherosclerosis of the renal artery, called renal artery stenosis.

Narrowing of the renal artery decreases the renal perfusion pressure and renal blood flow, decreasing the GFR. If the narrowing becomes significant (~70%), cortical hypoxia occurs as well, causing loss of glomeruli and progressive loss of kidney function.

Clinical features

Ischaemic nephropathy can present in multiple different ways:

• Chronic kidney disease (progressive reduction of GFR)
• Acute kidney injury in people starting RAAS inhibitors
• Renovascular hypertension

Atherosclerosis occurs everyone simultaneously, so patients with ischaemic nephropathy usually already have symptoms of atherosclerosis elsewhere, like CAD, CVD, or PAD.

Diagnosis and evaluation

Doppler ultrasound reveals narrowing of the renal artery.

Treatment

General anti-atherosclerotic and renoprotective treatment, like statin, RAAS inhibitors, antihypertensives, etc. Renal revascularization is an option.