How does high cholesterol affect your kidneys?

Written by: Dr Christopher Lawrence
Published: | Updated: 26/10/2023
Edited by: Laura Burgess

High cholesterol on its own does not directly affect the kidneys but it can affect the blood supply. Cholesterol plaque can clog the renal arteries and cut off blood flow to the kidneys, which can result in a loss of their function.

We’ve asked consultant nephrologist Dr Christopher Lawrence to explain how high cholesterol can put a patient at high kidney disease risk and whether any damage made to the kidneys can be reversed.
 

What kinds of kidney problems can high cholesterol lead to?

The indirect effects of cardiovascular disease can lead to the heart working less well as a pump, providing the kidneys with insufficient blood, nutrients and oxygen resulting in the nephrotic syndrome.

The direct effects of cholesterol on the blood supply to the kidneys can result in what we term atherosclerotic renovascular disease (ARVD). This is a narrowing of the blood supply to the kidneys.

Atherosclerotic renovascular disease is more common in older male smokers. The condition can present with deteriorating kidney function with ‘bland urinary sediment.’ In other words, the urine does not normally contain blood and protein on the dipstick test.

Sometimes the condition is suspected when the kidney function deteriorates after certain blood pressure tablets are started. These are usually an angiotensin-converting enzyme inhibitor, like Ramipril, or angiotensin receptor blocker, like Losartan.


 Image of magnetic resonance angiogram showing a tight early truncal stenosis (narrowing) of the left renal artery.
 

Is this damage reversible?

The damage caused to the kidneys by cardiovascular disease generally requires carefully balancing the requirements of the heart and the kidneys. This is done through dietary salt restriction, superb control of diabetes and through fine-tuning of the relevant medicines used to improve the heart function.

Atherosclerotic renovascular disease can sometimes be treated with a balloon or a stent, very similar to how angina is treated. The process of atherosclerosis is usually considered to be a progressive condition. However, when a narrowing (like the one in the image above) occurs, it is possible, in carefully selected cases, to intervene by performing an angiogram to open up the blood supply and restore blood flow to the kidney. This hopefully reduces the requirement for blood pressure tablets and perhaps slow the deterioration in the kidney function.

The scientific evidence for intervening on renal artery narrowing is not particularly supportive. This does not mean that it is not helpful for some people, but it does mean that it will not be the right option for everyone.

Dr Christopher Lawrence

By Dr Christopher Lawrence
Nephrology

Dr Christopher Lawrence is a leading consultant nephrologist in Hitchin, Watford and Harpenden, who holds a special interest in kidney problems, including kidney transplantation, kidney disease and acute kidney injury, and he also treats hypertension. He has a clinic at the Spire Bushey Hospital in Watford, 15 miles from London.

Dr Lawrence studied medicine at St Mary’s Hospital Medical School and qualified with his medical degree in 2001. After working at renowned hospitals in across London, he joined the prestigious North Thames Nephrology training rotation as a specialist registrar. Dr Lawrence trained in nephrology, transplantation and general medicine at the Hammersmith Hospital, The Lister Hospital, The Hillingdon Hospital and Southend University Hospital. During this time, he also gained a master’s degree in law.

Dr Lawrence was recently elected a fellow of the Royal College of Physicians. He is a skilled operator who performs common kidney related procedures, such as ultrasound-guided biopsy of native and transplant kidneys and central venous catheter insertion. He also undertakes medicolegal work.


  • Related procedures
  • Kidney transplantation
    Hypertension (high blood pressure)
    Vascular disease
    Gallstones
    Smoking cessation (quitting)
    Diabetes
    Acute kidney failure
    Diabetic nephropathy
    Nephritic syndrome
    Nephrotic syndrome
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