NephrologyTier 2Topic

Imaging - renal angiogram

Role

Direct catheter-based or CT/MR angiographic imaging of the renal arterial (and sometimes venous) circulation
Used diagnostically (renal artery stenosis) and therapeutically (angioplasty/stenting, embolisation)
Reserved for cases where non-invasive imaging (Doppler US, CTA, MRA) is inconclusive, or when intervention is planned in the same setting

Renal artery stenosis

Renal artery stenosis - atherosclerotic (older patients, ostial/proximal, often with other vascular disease) vs fibromuscular dysplasia (younger women, mid/distal artery, "string of beads" appearance)
Renal artery stenosis is a cause of secondary hypertension and can cause ischaemic nephropathy if severe/bilateral

Diagnostic use

Catheter angiography remains the gold standard for renal artery stenosis, though CTA/MRA are usually first-line non-invasive tests
Trauma/haemorrhage - angiography +/- embolisation for active bleeding (post-biopsy, traumatic)

Intervention

Angioplasty +/- stenting for fibromuscular dysplasia (good response) - atherosclerotic renal artery stenosis stenting has a more limited evidence base (CORAL trial - no significant benefit over medical therapy alone for most patients)
Embolisation for renal haemorrhage (post-biopsy, trauma, angiomyolipoma bleeding), preserving as much functioning parenchyma as possible

Indications

Renovascular hypertension, fibromuscular dysplasia, renal artery aneurysm, angiomyolipoma (embolisation)

Contrast risk

Contrast-induced nephropathy risk applies - pre-procedure hydration and minimising contrast volume in patients with reduced renal function

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