Diagnosing Vascular Causes of Renal Failure

15 October 1995 | Volume 123 Issue 8 | Pages 601-614

The incidence of renal failure due to vascular diseases is increasing. Two reasons for this are the epidemic of atherosclerotic vascular disease in the aging population and the widespread use of vasoactive drugs that can adversely affect renal function. These vascular causes of renal failure include vasomotor disorders such as that associated with nonsteroidal anti-inflammatory drugs, small-vessel diseases such as cholesterol crystal embolization, and large-vessel diseases such as renal artery stenosis. These causes of azotemia are less familiar to physicians than more classic causes, such as acute tubular necrosis, and are less likely to be recognized in their early stages. This article describes the various vascular diseases that impair renal function and outlines the steps necessary to identify them. Although some of these conditions, such as renal artery stenosis, can gradually impair function, the vascular causes of acute renal failure are emphasized in this article. Because the vasculitides primarily cause renal failure through secondary glomerulonephritis, they are mentioned only briefly. Extensive testing is rarely necessary because the cause is usually suspected through syndrome recognition. The diagnosis can then be confirmed by the results of one or two additional tests or by improved renal function after treatment.

Author and Article Information

From Rhode Island Hospital and Brown University School of Medicine, Providence, Rhode Island. For the current author address, see end of text.
Acknowledgments: The author thanks Douglas Shemin, MD, Thomas Wachtel, MD, Lance Dworkin, MD, and Dianne Abuelo, MD, for comments on the manuscript; Alfredo Esparza, MD, for the photoµgraphs; and Charlene McGloin for secretarial assistance.
Requests for Reprints: J. Gary Abuelo, MD, Division of Renal Diseases, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903.