For unilateral renal artery stenosis, which therapy is recommended?

For unilateral renal artery stenosis, which therapy is recommended?

• A. Beta-blockers
• B. ACE inhibitors or ARBs
• C. Calcium channel blockers
• D. Diuretics

Answer: (B)

In unilateral renal artery stenosis, the problem is overactivity of the renin–angiotensin system driving both high blood pressure and reduced perfusion to the affected kidney. Blocking angiotensin II with an ACE inhibitor or an ARB directly targets this mechanism, lowering systemic blood pressure and reducing the pressure the kidneys must work against. With one healthy kidney (the contralateral one) able to maintain overall GFR, this class can control hypertension and offer renal protection while the stenotic kidney relies less on angiotensin II–mediated efferent arteriolar constriction. But start these with caution: initiating an ACE inhibitor or ARB can cause a rise in creatinine as the stenotic kidney loses its compensatory mechanism, so monitor renal function and potassium after starting or increasing therapy. Other antihypertensives (beta-blockers, calcium channel blockers, diuretics) manage blood pressure but don’t address the RAAS-driven pathophysiology as directly, which is why ACE inhibitors or ARBs are the preferred option in unilateral disease.

In unilateral renal artery stenosis, the problem is overactivity of the renin–angiotensin system driving both high blood pressure and reduced perfusion to the affected kidney. Blocking angiotensin II with an ACE inhibitor or an ARB directly targets this mechanism, lowering systemic blood pressure and reducing the pressure the kidneys must work against. With one healthy kidney (the contralateral one) able to maintain overall GFR, this class can control hypertension and offer renal protection while the stenotic kidney relies less on angiotensin II–mediated efferent arteriolar constriction.

But start these with caution: initiating an ACE inhibitor or ARB can cause a rise in creatinine as the stenotic kidney loses its compensatory mechanism, so monitor renal function and potassium after starting or increasing therapy. Other antihypertensives (beta-blockers, calcium channel blockers, diuretics) manage blood pressure but don’t address the RAAS-driven pathophysiology as directly, which is why ACE inhibitors or ARBs are the preferred option in unilateral disease.