Does ADPKD Cause Renal Artery Stenosis?
ADPKD does not typically cause renal artery stenosis as a primary disease manifestation, and routine screening for renal artery stenosis is not recommended in ADPKD patients. 1
Evidence from Guidelines
The most recent and comprehensive KDIGO 2025 guidelines explicitly state that routine screening of vascular abnormalities of nonintracranial large arteries has no role in people with ADPKD unless there is a familial history of vascular aneurysms or dissections. 1 This guideline recommendation notably does not include renal artery stenosis among the recognized vascular complications of ADPKD.
Recognized Vascular Manifestations in ADPKD
The KDIGO 2025 guidelines comprehensively catalog the extrarenal vascular manifestations of ADPKD, which include: 1
- Intracranial aneurysms (12.9% prevalence)
- Thoracic aortic aneurysms (~1.5% prevalence)
- Coronary artery dissection (rare)
- Carotid and vertebral artery abnormalities (mentioned but not detailed in the provided excerpts)
Notably absent from this comprehensive list is renal artery stenosis, suggesting it is not a recognized primary manifestation of ADPKD. 1
Rare Case Reports vs. Systematic Association
While isolated case reports exist documenting renal artery occlusion in ADPKD patients with severe hypertension 2, these represent exceptional cases rather than a systematic disease feature. One case report from 2014 described a 38-year-old woman with ADPKD and left renal artery total occlusion, but the authors noted this association is uncommon and should only be considered in cases of severe or resistant hypertension. 2
Clinical Implications for Hypertension Management
The key clinical pitfall is confusing the mechanism of ACE inhibitor-induced renal dysfunction in ADPKD with bilateral renal artery stenosis:
- ACE inhibitors can cause reversible renal failure in ADPKD patients with massive cystic involvement and compromised renal function, similar to the mechanism seen in bilateral renal artery stenosis. 3
- However, this occurs due to the bilateral nature of the cystic disease itself compressing renal vasculature, not due to primary renal artery stenosis. 3
- Eight episodes of reversible acute renal deterioration were documented in five ADPKD patients receiving ACE inhibitors, particularly when combined with diuretics or during cyst hemorrhage. 3
When to Consider Vascular Imaging
Renal vascular imaging should only be pursued in ADPKD patients with:
- Severe or resistant hypertension that is difficult to control 2
- Familial history of aortic root or thoracic aortic aneurysms (though this targets aortic screening, not renal arteries) 1
- Acute deterioration in renal function on ACE inhibitors that does not reverse with medication discontinuation 3
The standard approach remains blood pressure monitoring and management with ACE inhibitors or ARBs as first-line agents, with caution in patients with advanced disease and massive cystic involvement. 1