Figure 142:

Progressive Atherosclerosis, Renal-Artery Stenosis, and ischemic Nephropathy.

In the early phase (Panel A), there is mild athersclerosis of the perirenal abdominal aorta and normal renal function. Renal blood flow, renal mass, and the serum creatinine concentration are normal. The dimensions of the kidneys are normal, and there is no cortical atrophy. The total glomerular filtration rate (100ml per minute) and the glomerular filtration rate in each kidney(50ml per minute) are normal.

As the disease progresses (Panel B), there is progressive aortic atherosclerosis and severe unilateral renal-artery stenosis. The left kidney is smaller than the right, and there may be cortical thinning and asymmetry in renal blood flow.The serun creatinine concentration remains normal as long as the right kidney is normal, despite the loss of renal mass. The total glomerular filtration rate maybe normal (100ml per minute) or only slightly depressed owing to compensatory changes in the right kidney, but renal blood flow is decreased in the left kidney (35ml per minute).

In advanced disease (PanelC), there is bulky atherosclerotic plaques in the perirenal aorta and severe bilateral renal-artery stenosis. Both kidneys are small, and there is marked cortical thinning and irregularity. Loss of more than 50% of renal mass is usually associated with an elevation in the serum creatinine concentration (ischemic nephropathy), which may not be reversible. The total glomerular filtration rate (30ml per minute) and the glomerular rate in each kidney (15ml per minute) are depressed.