Atherosclerotic renal artery stenosis: current status and future directions

Atherosclerotic renal artery stenosis is a common, progressive problem that increases in prevalence with age. It can have important clinical consequences such as hypertension, pulmonary edema, and renal failure. In addition, it is associated with increased cardiovascular mortality. The purpose of this review is to describe the current status of knowledge and future directions for this evolving field.

In patients who are suspected of having the disease, duplex Doppler ultrasound and magnetic resonance angiography remain the most promising noninvasive screening tests. Percutaneous revascularization continues to advance, and technical success is possible in the vast majority of patients. Revascularization for hypertension is of modest clinical benefit. Limited information is available on the effect of revascularization on preservation of renal function or cardiovascular events and mortality.

Further studies are still needed focusing on the identification of which patients will derive benefit from percutaneous revascularization and whether intervention provides an advantage over medical therapy, particularly with respect to preservation of renal function and reduction in cardiovascular morbidity and mortality.