What is the pathophysiology of renal artery stenosis (RAS)?

Updated: Nov 02, 2020
  • Author: Bruce S Spinowitz, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

In patients with atherosclerosis, the initiator of endothelial injury is not clear. However, dyslipidemia, hypertension, cigarette smoking, diabetes mellitus, viral infection, immune injury, and increased homocysteine levels may contribute to endothelial injury. 

The formation of atherosclerotic lesions involves increased permeability of endothelium to plasma macromolecules (eg, low-density lipoprotein [LDL]), increased turnover of endothelial cells and smooth muscle cells, and increased numbers of intimal macrophages. When atherogenic lipoproteins exceed certain critical levels, the mechanical forces may enhance lipoprotein insudation in these regions, leading to early atheromatous lesions.


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