Newspapers, magazines and TV commercials carry numerous warnings of the risks of high blood cholesterol levels and smoking for heart disease. Coronary artery narrowing leading to angina, acute heart attacks, and sudden death is well known to be related to blood cholesterol and smoking. We hear much less – practically nothing – about the effects of these two risks on kidney disease. And yet, an important connection exits. The common denominator is arteriosclerosis. Elevated blood cholesterol and smoking lead to premature arteriosclerosis, not only in the blood vessels of the heart, but also throughout the body. The heart has received all of the publicity because heart disease is so dramatic and a heart attack can be fatal. However, other blood vessels also become narrowed by arteriosclerosis. In the case of the blood vessels that lead to the kidneys, this can result in high blood pressure and kidney failure. Here is what happens.
Narrowing or blockage of the main arteries that supply the kidneys by arteriosclerosis is called (not surprisingly) renal artery stenosis. Although there are other rare causes of renal artery stenosis, arteriosclerosis is by far the most common cause. That is where the similarity to coronary heart disease comes in. In the case of both the heart and the kidneys, arteriosclerosis squeezes off the blood supply to these vital organs. The big difference between the heart and the kidneys, however, is that renal artery stenosis is a silent disease. There are no symptoms so people don’t know it is happening.
HOW CAN I FIND OUT IF I HAVE RENAL ARTERY STENOSIS?
Because there are no early symptoms, it is unlikely that you or your doctor would consider the diagnosis. However, high blood pressure can be a result of renal artery stenosis. A clue to the diagnosis is that the high blood pressure may not respond well to blood pressure drugs or other measures. If this is the case, your doctor may recommend special tests, such as a radionuclide scan, a kidney CT scan, or a renal arteriograph, any of which could establish the correct diagnosis. If renal artery stenosis is found, balloon angioplasty, a stent, or surgical repair can be tried in order to prevent further damage to the kidneys. However, the decision to undertake an invasive procedure depends on the general health of the individual. Extensive arteriosclerosis in many other blood vessels throughout the body is often a reason not to run the risks of an invasive procedure. If both renal arteries are narrowed by arteriosclerosis, kidney function is gradually lost over a period of months to years. The final result is end stage renal failure (ESRD), requiring dialysis treatment.
IS THERE PREVENTION?
Yes there is. Since smoking and high blood cholesterol have been established as key factors in the development of arteriosclerosis, it seems logical that the best way to avoid getting renal artery stenosis in the first place is to stop smoking and lower your cholesterol. It takes many years for arteriosclerosis to develop, so the younger you are when you stop smoking and attend to your blood cholesterol, the better. You could prevent renal artery stenosis from developing and benefit your heart and blood vessels throughout your body as well.
- Norman
Bank, MD
Last updated: 12/16/02
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