Renal artery stenosis: pathophysiology and treatment

Renal artery stenosis (RAS) is a disease that consists of a broad spectrum of different entities with different pathophysiologies that require varied approaches to diagnosis and treatment. The two most common causes of RAS are fibromuscular dysplasia and atherosclerosis, which consist of approximately 10 and 90% of RAS, respectively. Renovascular diseases are divided into two broad subtypes: hypertension and nephropathy. While models explaining the pathophysiology of RAS indicate a direct relationship between RAS and renovascular hypertension and nephropathy, this has not been fully seen in humans with chronic arterial narrowing. Furthermore, clinical data from humans has not fully demonstrated the benefit one would expect from treatment of RAS with regards to improvement in renovascular hypertension and nephropathy. The goal of this article is to review the pathophysiology of RAS, and discuss outcomes of treatment with regard to renovascular hypertension and nephropathy.