Renal Arter Stenozuna Yaklaşım

Renal artery stenosis (RAS) is an important vascular disorder that may cause renovascular hypertension and renal dysfunction by reducing renal perfusion. Atherosclerosis is the most common etiology, predominantly affecting older individuals with cardiovascular risk factors, whereas fibromuscular dysplasia mainly occurs in younger women. The underlying pathophysiology involves activation of the renin-angiotensin-aldosterone system, sodium and water retention, oxidative stress, and inflammation. Resistant hypertension, unexplained deterioration in renal function, asymmetric kidney size, and recurrent episodes of flash pulmonary edema should raise clinical suspicion. Duplex Doppler ultrasonography is the first-line diagnostic imaging modality, while computed tomography angiography, magnetic resonance angiography, and catheter angiography may be used when indicated. Optimal medical therapy, including blood pressure control and management of cardiovascular risk factors, remains the cornerstone of treatment. Revascularization should be considered in selected patients, particularly those with recurrent pulmonary edema, resistant hypertension, or ischemic nephropathy. Treatment decisions should consider the underlying etiology, hemodynamic significance of the stenosis, and the condition of the renal parenchyma. Regular follow-up after intervention is essential to detect restenosis.