[Renovascular disease: challenge to general practitioners and internists]

Renovascular disease is defined as renal insufficiency secondary to fibromuscular or atherosclerotic renal artery stenosis. The immediate cause of renal insufficiency is not hypertension but ischemia and hyper-reninaemia that result from critical (greater than 80%) renal artery stenosis. Hyper-reninaemia damages also the contra lateral non-ischemic kidney. The key to successful treatment of renovascular disease is its diagnosis before the onset of renal insufficiency (> 180-200 micromol/l serum creatinine). The goal of interventional therapy is the prevention of symptomatic renal insufficiency and end-stage renal failure; the indication for intervention is the presence of greater than 80-85% renal artery stenosis. Patients diagnosed with non-critical renal artery stenosis (< 80%) do not need immediate intervention, only close follow-up.