renal artery stenosis


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  • Clinical

    • atherosclerosis (male, 50s, imaging shows stenosis at ostia or proximal main)
    • fibromuscular dysplasia (female, young, imaging shows string of beads)
    • rare causes
      • dissection, aneurysm, AVM
      • thromboemboli
      • arteritis, radiation, transplant
      • neurofibromatosis
    • 30% is bilateral

  • Gross

    • small kidney
      • uniform if main artery stenosis
      • partial if segmental artery stenosis
    • diffuse coarse granular subcortical surface

  • Histology

    • juxtaglomerular apparatus enlargement
    • atherosclerosis, nephrosclerosis, tubular atrophy
    • fibromuscular dysplasia types
      • medial fibroplasia with aneurysms: most common, medial thickening alternates with thinning, no fibrosis
      • perimedial fibroplasia: 2nd most common, fibrosis of outer half of media
      • intimal fibroplasia: circumferential intimal thickening along main artery
      • medial hyperplasia: localized thickened segment
      • periarterial fibroplasia: rarest, dense collagen in adventitia
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